Longitudinal Trajectories of Post-Stroke Depression Symptom Subgroups.
Neurorehabilitation and neural repair
BACKGROUND:Post-stroke depressive symptoms are prevalent and impairing, and elucidating their course and risk factors is critical for reducing their public health burden. Previous studies have examined the course of post-stroke depression, but distinct depressive symptom dimensions (eg, somatic symptoms, negative affect [eg, sadness], anhedonia [eg, loss of interest]) may vary differently over time. OBJECTIVE:The present study examined within-person and between-person associations between depressive symptom dimensions across 3 timepoints in the year following discharge from in-patient rehabilitation hospitals, as well as the impact of multiple clinical variables (eg, aphasia). METHODS:Stroke survivors completed the Center for Epidemiologic Depression Scale (CES-D) at discharge from post-stroke rehabilitation ("T1") and at 3-month ("T2") and 12-month ("T3") follow-ups. Scores on previously identified CES-D subscales (somatic symptoms, anhedonia, and negative affect) were calculated at each timepoint. Random intercept cross-lagged panel model analysis examined associations between symptom dimensions while disaggregating within-person and between-person effects. RESULTS:There were reciprocal, within-person associations between somatic symptoms and anhedonia from T1 to T2 and from T2 to T3. Neither dimension was predictive of, or predicted by negative affect. CONCLUSIONS:The reciprocal associations between somatic symptoms and anhedonia may reflect a "vicious cycle," and suggest these 2 symptom dimensions may be useful indicators of risk and/or intervention targets. Regularly assessing depression symptoms starting during inpatient rehabilitation may help identify stroke survivors at risk for depression symptoms and facilitate early intervention.
10.1177/15459683221143464
The etiology of poststroke-depression: a hypothesis involving HPA axis.
Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie
Approximately, one in three ischemic stroke survivors suffered from depression, namely, post-stroke depression (PSD). PSD affects functional rehabilitation and may lead to poor quality of life of patients. There are numerous explanations about the etiologies of PSD. Here, we speculated that PSD are likely to be the result of specific changes in brain pathology. We hypothesized that the stroke-induced hyperactivity of hypothalamic-pituitary-adrenal (HPA) axis plays an important role in PSD. Stroke initiates a complex sequence of events in neuroendocrine system including HPA axis. The HPA axis is involved in the pathophysiology of depression, especially, the overactivity of the HPA axis occurs in major depressive disorder. This review summarizes the possible etiologies of PSD, focusing on the stroke-induced activation of HPA axis, mainly including the stress followed by severe brain damage and the proinflammatory cytokines release. The role of hyperactive of HPA axis in PSD was discussed in detail, which includes the role of high level corticotropin-releasing hormone in PSD, the effects of glucocorticoids on the alterations in specific brain structures, the expression of enzymes, excitotoxicity, the change in intestinal permeability, and the activation of microglia. The relationship between neuroendocrine regulation and inflammation was also described. Finally, the therapy of PSD by regulating HPA axis, neuroendocrine, and immunity was discussed briefly. Nevertheless, the change of HPA axis and the occurring of PSD maybe interact and promote on each other, and future investigations should explore this hypothesis in more depth.
10.1016/j.biopha.2022.113146
Post-stroke depression, anxiety, and stress symptoms and their associated factors: A cross-sectional study.
Almhdawi Khader A,Alazrai Alza,Kanaan Saddam,Shyyab Awni A,Oteir Alaa O,Mansour Zaid Modhi,Jaber Hanan
Neuropsychological rehabilitation
Individuals post-stroke are subject to increased levels of mental health symptoms. This is a cross-sectional study explored levels of depression, anxiety, and stress symptoms and identified their predictors among Jordanian individuals with stroke. Outcome measures included Depression Anxiety Stress Scale, Fugl-Meyer assessment, goniometry, hand-held dynamometry, nine-hole peg test, Ashworth scale, Motor Activity Log, ten-meter walk test, and 12-item Short-Form health survey (SF-12). Descriptive analyses were used to describe prevalence of mental health symptoms and multiple variable linear regression models were used to identify their predictors. A total of 153 individuals participated in the study. Proportions of participants with mental health symptoms were 74.5% for depression, 52.9% for anxiety, and 68% for stress. Significant predictors of post-stroke mental health symptoms were SF-12 Mental Composite Score and grip strength for depression, anxiety, and stress. Depression and stress symptoms were significantly associated with discontinuation of rehabilitation services. Furthermore, self-reports of fewer sleep hours was significantly associated with anxiety and stress. Finally, Gender and self-reported physical diseases other than stroke were significantly associated with depression symptoms. We conclude that high proportions of Jordanian individuals' post-stroke have suffered mental health symptoms. Future studies are required to design effective interventions to improve post-stroke mental health.
10.1080/09602011.2020.1760893
Effect of traditional Chinese medicine emotional therapy on post-stroke depression: A protocol for systematic review and meta-analysis.
Medicine
BACKGROUND:Post-stroke depression has seriously affected the rehabilitation and quality of life of patients, and there is no reliable treatment plan at present. Nursing plays an important role in the recovery of patients, some studies have pointed out that traditional Chinese medicine emotional therapy has advantages in improving post-stroke depression and promoting rehabilitation, but it is lack of evidence-based basis. The purpose of this study is to systematically evaluate the effect of traditional Chinese medicine emotional therapy on the improvement of post-stroke depression. METHOD:We will search CNKI, Wanfang, VIP and CBM, PubMed, Embase, Web of Science and the Cochrane Library database, and search the randomized controlled trial on traditional Chinese medicine emotional therapy in patients with post-stroke depression from the establishment of the database to February 2021. The language is limited to English and Chinese. The quality of the included study is independently extracted and the literature quality is evaluated by 2 researchers. And meta-analysis is performed on the included literature using RevMan5.3 software. RESULT:In this study, the effect of traditional Chinese medicine emotional therapy on the improvement of post-stroke depression is evaluated by patient psychiatric scale score, compliance evaluation, quality of life evaluation and other indicators. CONCLUSION:This study will provide reliable evidence-based basis for establishing a reasonable and effective nursing scheme for patients with post-stroke depression. ETHICS AND DISSEMINATION:Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval will not be required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences. OSF REGISTRATION NUMBER:DOI 10.17605/OSF.IO/KA7G3.
10.1097/MD.0000000000025386
Acupuncture for post-stroke depression: a systematic review and network meta-analysis.
BMC psychiatry
BACKGROUND:Patients with post-stroke depression (PSD) usually experience anxiety, hopelessness, and insomnia, which have a negative impact on their daily activities and post-stroke rehabilitation. Acupuncture (AC), as a minimally invasive technique, has become a popular choice for improving depression symptoms. However, it is still unclear which therapy is associated with the best outcomes for PSD. In this review, we aimed to explore the impact of AC in alleviating symptoms of PSD and to evaluate the difference in effectiveness between AC combined with pharmacotherapies and various non-pharmacotherapies. METHODS:Six databases and three clinical trials registration platforms were searched from inception to March 2023. Randomized clinical trial comparing needle-based AC with pharmacotherapy, and other non-pharmacotherapy or invalid group were included. Two independent reviewers identified eligible studies, and collected data using a pre-made form. A Bayesian network meta-analysis was conducted to assess and compare different techniques using RStudio 3.6.0 with the package 'GEMTC' V.0.8.1. The primary outcome was the efficacy for PSD assessed by scales measuring depressive symptoms. The secondary outcomes were effectiveness for neurological function and the quality of life. The ranking probabilities for all treatment interventions was performed using the Surface Under the Cumulative Ranking curve (SUCRA). The risk of bias was assessed by using the Revised Cochrane Risk of Bias tool 2. RESULTS:Sixty-two studies, involving 5308 participants published from 2003 to 2022, were included. The results showed that compared with western medicine (WM) (defined as pharmacotherapy for PSD), AC alone or with repetitive transcranial magnetic stimulation (RTMS), Traditional Chinese medicine (TCM) alone or with WM, were superior for alleviating depression symptoms. Compared to Usual Care, AC alone or plus other therapies could significantly decrease scores on the Hamilton Depression Rating scale. According to result of SUCRA, AC plus RTMS had the highest probability of improving depressive symptoms with a probability of 49.43%. CONCLUSIONS:The results of this study indicate that AC alone or combined with other therapies appears to be effective in improving depression symptoms of stroke survivors. Moreover, in comparison to WM, AC alone or plus RTMS, TCM, TCM with WM, or WM, were more effective in improving depression symptoms of PSD. Also, AC with RTMS seems to be the most effective with the highest probability. REGISTRATION:This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database in November 2020 and updated in July 2021. The registration number is CRD42020218752.
10.1186/s12888-023-04749-1
[Transcranial direct current stimulation: a new tool for neurostimulation].
Thibaut A,Chatelle C,Gosseries O,Laureys S,Bruno M-A
Revue neurologique
Transcranial direct current stimulation (tDCS) is a safe method to modulate cortical excitability. Anodal stimulation can improve the stimulated area's functions whereas cathodal stimulation reduces them. Currently, a lot of clinical trials have been conducted to study the effect of tDCS on post-stroke motor and language deficits, in depression, chronic pain, memory impairment and tinnitus in order to decrease symptoms. Results showed that, if an effect is observed with tDCS, it does not persist over time. Current studies suggest that direct current stimulation is a promising technique that helps to improve rehabilitation after stroke, to enhance cognitive deficiencies, to reduce depression and to relieve chronic pain. Moreover, it is a safe, simple and cheap device that could be easily integrated in a rehabilitation program.
10.1016/j.neurol.2012.05.008
A comprehensive database of published tDCS clinical trials (2005-2016).
Lefaucheur Jean-Pascal
Neurophysiologie clinique = Clinical neurophysiology
Transcranial direct current stimulation (tDCS) is a technique of noninvasive cortical stimulation allowing significant modification of brain functions. Clinical application of this technique was reported for the first time in March 2005. This paper presents a detailed list of the 340 articles (excluding single case reports) which have assessed the clinical effect of tDCS in patients, at least when delivered to cortical targets. The reviewed conditions were: pain syndromes, Parkinson's disease, dystonia, cerebral palsy, post-stroke limb motor impairment, post-stroke neglect, post-stroke dysphagia, post-stroke aphasia, primary progressive aphasia, multiple sclerosis, epilepsy, consciousness disorders, Alzheimer's disease and other types of dementia, tinnitus, depression, auditory hallucinations and negative symptoms of schizophrenia, addiction and craving, autism, and attention disorders. The following data were collected: (i) clinical condition; (ii) study design; (iii) sample size; (iv) anode and cathode locations; (v) stimulation intensity and electrode area; (vi) number and duration of sessions; (vii) clinical outcome measures and results. This article does not include any meta-analysis and aims simply at providing a comprehensive overview of the raw data reported in this field to date, as an aid to researchers.
10.1016/j.neucli.2016.10.002
The use of tDCS and CVS as methods of non-invasive brain stimulation.
Been Gregory,Ngo Trung T,Miller Steven M,Fitzgerald Paul B
Brain research reviews
Transcranial direct current stimulation (tDCS) and caloric vestibular stimulation (CVS) are safe methods for selectively modulating cortical excitability and activation, respectively, which have recently received increased interest regarding possible clinical applications. tDCS involves the application of low currents to the scalp via cathodal and anodal electrodes and has been shown to affect a range of motor, somatosensory, visual, affective and cognitive functions. Therapeutic effects have been demonstrated in clinical trials of tDCS for a variety of conditions including tinnitus, post-stroke motor deficits, fibromyalgia, depression, epilepsy and Parkinson's disease. Its effects can be modulated by combination with pharmacological treatment and it may influence the efficacy of other neurostimulatory techniques such as transcranial magnetic stimulation. CVS involves irrigating the auditory canal with cold water which induces a temperature gradient across the semicircular canals of the vestibular apparatus. This has been shown in functional brain-imaging studies to result in activation in several contralateral cortical and subcortical brain regions. CVS has also been shown to have effects on a wide range of visual and cognitive phenomena, as well as on post-stroke conditions, mania and chronic pain states. Both these techniques have been shown to modulate a range of brain functions, and display potential as clinical treatments. Importantly, they are both inexpensive relative to other brain stimulation techniques such as electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS).
10.1016/j.brainresrev.2007.08.001
[Participation after stroke: the influence of depression in outpatient neurological rehabilitation].
Marheineke J,Deck R,Reuther P,Pöppl D,Theves F,Kohlmann T
Der Nervenarzt
BACKGROUND:Depressiveness is a known and common problem after stroke, which puts a great burden on those affected. The main goal for stroke rehabilitation is to achieve the maximum possible self-determination and participation in the community. This research study examined how depressive symptoms influence the course of participation in outpatient neurological rehabilitation. METHODS:Stroke rehabilitants from 17 German outpatient neurological rehabilitation centers were interviewed in a multicentric observational study. Within the current work, data on participation and depressive symptoms recorded at the beginning and at the end of rehabilitation by self-assessment questionnaires, were evaluated. RESULTS:Data of 342 rehabilitants were considered. Results of a multinomial logistic regression analysis indicated that the depression value at the end of rehabilitation, in particular, proved to be a good predictor for the improvement in participation. The lower the depressiveness, the more likely an improvement in participation. At the beginning of the rehabilitation program there were no significant differences between mean depression scores of patients who improved and patients who deteriorated. DISCUSSION:A relationship between depressiveness and participation was shown. The treatment of depressive symptoms through timely administered psychotherapeutic and medicinal care and general activity promotion could influence the participation in a beneficial way.
10.1007/s00115-018-0622-1
Correlative study on risk factors of depression among acute stroke patients.
Jiang X-g,Lin Y,Li Y-s
European review for medical and pharmacological sciences
BACKGROUND:The causes of post-stroke depression (PSD) were complex, and it is hard to identify the consistent risk factors because the correlation may change along with time. AIM:To study the prevalence and multiple correlation factors of PSD in acute stroke patients. PATIENTS AND METHODS:The patients within over 2-6 weeks after stroke were collected and divided into depression group, depressive symptom group, and control group according to the Hamilton Depression Rating Scale for Depression. The NIH (National Institute of Health) Stroke Scale, the Barthel index (BI), the Instrumental Activities of Daily Living (IADL), and the Mini-Mental State Examination (MMSE) were respectively used to evaluate the neurologic impairment, Ability of Daily Life, and cognitive function of patients. RESULTS:PSD was associated with lower incomes (p < 0.05), but not associated with education level, medical insurance, and nature of the acute stroke (p > 0.05). The lesion location in the left hemisphere of the brain had a higher morbidity than that in the right hemisphere or both sides. There was a significant difference in the incidence of PSD between multifocal lesions and single lesion (p < 0.01). CONCLUSIONS:Lower income, cognitive dysfunctions, poor activities of daily life, poor social support, and history of hypertension and previous stroke were risk factors for the acute stroke patients to get depression. Stroke survivors with left hemisphere of the brain and more lesions (≥ 2) have more chance to get the PSD.
Investigation of the emotional network in depression after stroke: A study of multivariate Granger causality analysis of fMRI data.
Shi Yu,Liu Wei,Liu Ruifen,Zeng Yanyan,Wu Lei,Huang Shimin,Cai Guiyuan,Yang Jianming,Wu Wen
Journal of affective disorders
OBJECTIVE:Depression after stroke (DAS) is a serious complication of stroke that significantly restricts rehabilitation. Brain imaging technology is an important method for studying the emotional network of DAS. However, few studies have focused on dynamic interactions within the network. The aim of this study was to investigate the emotional network of frontal lobe DAS using the multivariate Granger causality analysis (GCA) method, a technique that can estimate the association among the brain areas to analyze functional magnetic resonance imaging (fMRI) data collected from DAS and no depression after stroke (NDAS). METHOD:Thirty-six first-time ischemic right frontal lobe stroke patients underwent resting-state fMRI (rs-fMRI) scans. The clinical assessment scale used for screening subjects was as follows: the 24-item Hamilton Rating Scale for Depression (HAMD-24), the National Institutes of Health Stroke Scale (NIHSS), the Mini-Mental State Examination (MMSE), and the Barthel Index (BI). The multivariate GCA method was used to analyze fMRI data collected from DAS and NDAS. RESULTS:The results showed positive regulations in the order from the ventromedial prefrontal cortex (VMPFC), the anterior cingulate cortex (ACC), and the amygdala (AMYG) to the thalamus, and when the interaction order is opposite, the moderating effect is negative. The thalamus could predict the negative activity of the insular (IC) via the ACC. The dorsolateral prefrontal cortex (DLPFC) could predict the activity of the ACC via the temporal pole (TP). CONCLUSION:This study found a VMPFC-ACC-AMYG-thalamus emotional circuit to explain the network between different brain regions associated with DAS. The DLPFC and TP play an important role in the emotional regulation of DAS, and the function of the IC is regulated negatively by the thalamus. These findings advance the neural theory of DAS, which is based on the functional relationship between different brain areas.
10.1016/j.jad.2019.02.020
Altered functional connectivity in post-ischemic stroke depression: A resting-state functional magnetic resonance imaging study.
Zhang Peiyao,Wang Jing,Xu Qin,Song Zheng,Dai Jianping,Wang Jun
European journal of radiology
OBJECTIVE:In previous studies, post-stroke depression (PSD) was found to be related to stroke characteristics as well as social and psychological factors. This study identified altered functional connectivity (FC) in patients with PSD at the subacute phase in three brain networks: default mood network (DMN), cognitive control network (CCN), and affective network (AN). The correlation between FC and the severity of PSD was investigated. MATERIALS AND METHODS:Resting-state functional magnetic resonance image (rs-fMRI) was performed on 26 PSD patients (6 females), 24 stroke patients without depression (5 females), and 24 age-matched normal controls (6 females) all aged 40-75 years. The FC values of DMN, CCN, and AN were calculated and compared among the three groups. The Hamilton Depression Rating Scale (HDRS) (17 items) was employed and the score was correlated with FC in the PSD group. RESULTS:The FCs of the three networks were altered in PSD patients at the subacute phase compared to stroke patients without depression and normal controls (NC). Moreover, the left inferior parietal gyrus, the left orbital part of inferior frontal gyrus, and left angular gyrus (which indicated altered FC) were significantly correlated with HDRS scores in PSD patients. CONCLUSIONS:Alteration of the three neural networks might be correlated with the development of PSD at the subacute phase of stroke.
10.1016/j.ejrad.2018.01.003
A Study of the Brain Abnormalities of Post-Stroke Depression in Frontal Lobe Lesion.
Shi Yu,Zeng Yanyan,Wu Lei,Liu Wei,Liu Ziping,Zhang Shanshan,Yang Jianming,Wu Wen
Scientific reports
Post stroke depression (PSD) is a serious complication of stroke. Brain imaging is an important method of studying the mechanism of PSD. However, few studies have focused on the single lesion location. The aim of this study was to investigate the brain mechanism of frontal lobe PSD using combined voxel-based morphometry (VBM) and functional magnetic resonance imaging (fMRI). In total, 30 first-time ischemic frontal lobe stroke patients underwent T1 weighted MRI and resting-state fMRI scans. Clinical assessments included the 24-item Hamilton Rating Scale for Depression, the National Institutes of Health Stroke Scale, and the Mini-Mental State Examination. In our result, decreased gray matter (GM) volume in patients was observed in the prefrontal cortex, limbic system and motor cortex. The anterior cingulate cortex, selected as a seed to perform connectivity analyses, showed a greatly decreased functional connectivity with the prefrontal cortex, cingulate cortex, and motor cortex, but had an increased functional connectivity with the hippocampus gyrus, parahippocampa gyrus, insular, and amygdala. Stroke lesion location reduces excitability of brain areas in the ipsilateral brain. PSD affects mood through the brain network of the prefrontal-limbic circuit. Some brain networks, including motor cortex and the default mode network, show other characteristics of PSD brain network.
10.1038/s41598-017-13681-w
The relationship between frontal lobe lesions, course of post-stroke depression, and 1-year prognosis in patients with first-ever ischemic stroke.
Shi Yu-Zhi,Xiang Yu-Tao,Wu Shuo-Lin,Zhang Ning,Zhou Juan,Bai Ying,Wang Shuo,Wang Yi-Long,Zhao Xing-Quan,Ungvari Gabor S,Chiu Helen F K,Wang Yong-Jun,Wang Chun-Xue
PloS one
BACKGROUND AND PURPOSE:Most studies on post-stroke depression (PSD) have focused on a certain time point after stroke instead of the time course of PSD. The aim of this study was to determine the relationship between frontal lobe lesions, course of PSD over a year following the stroke onset, and the 1-year prognosis in patients with first-ever ischemic stroke. METHODS:A total of 1067 patients from the prospective cohort study on the incidence and outcome of patients with post stroke depression in China who were diagnosed with first-ever ischemic stroke and attended 4 follow-up visits at 14±2 days, 3 months, 6 months, and 1 year after stroke onset, were enrolled in the study. PSD was diagnosed according to DSM-IV. The course of PSD was divided into the following two categories: persistent/recurrent depression and no/transient depression. Patients with any ischemic lesion responsible for the indexed stroke event located in the frontal lobe were defined as patients with frontal lobe lesions. Modified Rankin Scale (mRS) ≥2 at 1-year was considered to be poor prognosis. RESULTS:There were 109 patients with and 958 patients without frontal lobe lesions that formed the frontal lobe (FL) and no-frontal lobe (NFL) groups, respectively. After adjusting for confounding variables, frontal lobe lesion was significantly associated with persistent/recurrent PSD (OR 2.025, 95%CI 1.039-3.949). Overall, 32.7% of patients in the FL group had poor prognosis at 1- year compared with 22.7% in the NFL group (P = 0.021). Compared with no/transient depression, persistent/recurrent depression was found to be an independent predictor of poor prognosis at 1-year both in FL and NFL groups. CONCLUSIONS:Long-term and periodical screening, evaluation and treatment are needed for PSD after the onset of ischemic stroke, particularly for patients with frontal lobe infarction.
10.1371/journal.pone.0100456
Factors associated with post-stroke depression and fatigue: lesion location and coping styles.
Wei Changjuan,Zhang Fang,Chen Li,Ma Xiaofeng,Zhang Nan,Hao Junwei
Journal of neurology
Post-stroke depression (PSD) and post-stroke fatigue (PSF) are frequent and persistent problems among stroke survivors. Therefore, awareness of signs and symptoms of PSD and PSF is important for their treatment and recovery from stroke. Additionally, since sudden serious illness can result in disequilibrium, early institution of a coping process is essential to restoring stability. The brain damage of stroke leaves patients with unique physical and mental dysfunctions for which coping maybe a key resource while rebuilding lives. We evaluated 368 consecutive patients with acute ischemic stroke for post-stroke emotional disorders at admission and 3 months later. PSD was evaluated by using the Beck Depression Inventory, and PSF was scored with the Fatigue Severity Scale. The Social Support Rating Scale and Medical Coping Modes Questionnaire were also used as measurement tools. Locations of lesions were based on MRI. Those scans revealed infarcts located in the basal ganglia, corona radiate and internal capsule and constituted the independent factors associated with PSF 3 months after stroke occurrence. Conversely, PSD was not related to lesion location. Acceptance-resignation related to PSD and PSF both at admission and 3 months after stroke. Avoidance was the independent factor most closely related to PSD, whereas confrontation was the independent factor best related to PSF at 3 months after stroke onset.
10.1007/s00415-015-7958-2
Factors that influence the severity of post-stroke depression.
Ilut S,Stan A,Blesneag A,Vacaras V,Vesa S,Fodoreanu L
Journal of medicine and life
AIM:The aim of this paper was to investigate whether the extent of neurological impairment, the location of ischemic lesions due to stroke are associated with the severity of post-stroke depression. MATERIALS AND METHODS:The study included 82 patients, who were diagnosed with acute ischemic stroke and post-stroke depression and were admitted to the Neurology Clinic of Cluj-Napoca County Emergency Hospital between 2009 and 2011. A head MRI was performed with a 1.5 Tesla. Psychometric assessment was performed by using several scales, including the Beck Depression Inventory and the Mini-Mental State Examination. The National Institutes of Health Stroke Scale (NIHSS) and the Barthel Index of Activities of Daily Living were used to produce a complete neurological assessment. RESULTS:Patients with severe depression had a lower score on the Quality of Life Scale (QOLS) and higher scores for the Barthel index, NIHSS and MMSE. A stroke located in the basal nuclei increased the probability of severe depression. The patients with fewer lesions (1-2) had a greater chance of developing mild or moderate depression compared to the patients with 3-4 lesions. A frontal localization of the stroke was almost twice as common in patients with severe depression. If the stroke affected the left hemisphere, there was a higher probability of severe depression. In multivariate analysis, a basal nuclei lesion, a left hemisphere stroke location, and an NIHSS score >11 were all independently associated with severe depression. CONCLUSION:The location of the stroke and the NIHSS score could be related to the severity of post-stroke depression. : NIHSS = The National Institutes of Health Stroke Scale; QQL = Quality of life Scale; BDI = Beck Depression Inventory; MMSE = Mini-Mental State Examination; PSD = Post-stroke depression; MRI = Magnetic resonance imaging.
[Real Time Fuctional Magnetic Resonance Imaging Biofeedback: a New Generation of Neurotherapy].
Mel'niko M Ye,Shtark M B,Savelov A A,Bruhl A
Zhurnal vysshei nervnoi deiatelnosti imeni I P Pavlova
The review summarizes the data related to the potential of the real time fMRI biofeedback (the rt-fMRI), a novel technology implementing instructing patients to modify the neural activity in the certain brain regions related to the disordered function. The recent positive results were gained for a treatment of the post-stroke impairments, the Parkinson disease, the pain syndrome, the tinnitus, the alcohol and nicotine abuse, the major depression, and phobias of contamination and spiders. The intervention Was found to be less promising for schizophrenia and nearly ineffective for the criminal antisocial personality disorder. The reliability of the results is mostly poor due to suboptimal study designs, lack of the control groups, and insufficient sample sizes. The article deals with biological basis of the technology, its current applications and perspectives; and also its method- ologicdl and methodical problems.
A Study of the Brain Functional Network of Post-Stroke Depression in Three Different Lesion Locations.
Scientific reports
Research on the mechanism of post stroke depression (PSD) is the key way to improve the treatment of PSD. However, the functional brain network of PSD has not been entirely supported by the results of functional magnetic resonance imaging (fMRI) studies. The aims of this study are to investigate the brain response of PSD in three different lesions. The brain responses of the three PSD subgroups were similar. However, each subgroup had its own characteristics of the brain network. In the temporal lobe subgroup, the right thalamus had increased degree centrality (DC) values which were different from the other two subgroups. In the frontal lobe subgroup, the left dorsolateral prefrontal cortex, caudate, and postcentral gyrus had increased DC values which were different from the other two subgroups. The hemodynamic response of PSD indicates that PSD has activities of similar emotional networks, of which the negative network realizes its function through the limbic system and default mode network. The brain network has unique characteristics for different lesion locations. The neurological function of the lesion location, the compensatory mechanism of the brain, and the mechanism of integrity and locality of the brain are the important factors in the individual emotional network.
10.1038/s41598-017-14675-4
Transcranial direct current stimulation: a roadmap for research, from mechanism of action to clinical implementation.
Chase Henry W,Boudewyn Megan A,Carter Cameron S,Phillips Mary L
Molecular psychiatry
Transcranial direct current stimulation (tDCS) is a promising method for altering the function of neural systems, cognition, and behavior. Evidence is emerging that it can also influence psychiatric symptomatology, including major depression and schizophrenia. However, there are many open questions regarding how the method might have such an effect, and uncertainties surrounding its influence on neural activity, and human cognition and functioning. In the present critical review, we identify key priorities for future research into major depression and schizophrenia, including studies of the mechanism(s) of action of tDCS at the neuronal and systems levels, the establishment of the cognitive impact of tDCS, as well as investigations of the potential clinical efficacy of tDCS. We highlight areas of progress in each of these domains, including data that appear to favor an effect of tDCS on neural oscillations rather than spiking, and findings that tDCS administration to the prefrontal cortex during task training may be an effective way to enhance behavioral performance. Finally, we provide suggestions for further empirical study that will elucidate the impact of tDCS on brain and behavior, and may pave the way for efficacious clinical treatments for psychiatric disorders.
10.1038/s41380-019-0499-9
After-effects of transcranial direct current stimulation (tDCS) on cortical spreading depression.
Liebetanz David,Fregni Felipe,Monte-Silva Katia K,Oliveira Manuella B,Amâncio-dos-Santos Angela,Nitsche Michael A,Guedes Rubem C A
Neuroscience letters
Abnormal cortical excitability influences susceptibility to cortical spreading depression (CSD) in migraine. Because transcranial direct current stimulation (tDCS) is capable of inducing lasting changes of cortical excitability, we investigated the after-effects of tDCS on the propagation velocity of CSD in the rat. Twenty-five anesthetised rats received either anodal, cathodal or sham tDCS. The stimulation was applied for 20 min at a current strength of 200 microA after the recording of three baseline CSD measurements. Starting 5 min after tDCS, a further three CSDs were elicited and CSD velocity recorded at intervals of 20 min. tDCS and CSD recording was performed under anaesthesia with chloralose and urethane. As compared to the baseline velocity of 3.14 mm/min, anodal tDCS induced a significant increase of propagation velocity during the first post-tDCS recording (3.49 mm/min). In contrast to anodal tDCS, neither cathodal tDCS nor sham tDCS, which consisted of an initial ramped DC stimulation lasting only 20 s, showed a significant effect on CSD propagation velocity. As anodal tDCS is known to induce a lasting increase of cortical excitability in the clinical setting, our results support the notion that CSD propagation velocity reflects cortical excitability. Since cortical excitability and susceptibility to CSD is elevated in migraine patients, anodal tDCS - by increasing cortical excitability - might increase the probability of migraine attack in these patients, even beyond the end of its application.
10.1016/j.neulet.2005.12.058
Transcranial direct current stimulation (tDCS) for fatigue in multiple sclerosis.
Ferrucci Roberta,Vergari Maurizio,Cogiamanian Filippo,Bocci Tommaso,Ciocca Matteo,Tomasini Emanuele,De Riz Milena,Scarpini Elio,Priori Alberto
NeuroRehabilitation
BACKGROUND:The debilitating fatigue that patients with multiple sclerosis (MS) commonly experience during day-to-day living activities responds poorly to current therapeutic options. Direct currents (DC) delivered through the scalp (transcranial DC stimulation or tDCS) at weak intensities induce changes in motor cortical excitability that persist for almost an hour after current offset and depend on current polarity. tDCS successfully modulates cortical excitability in various clinical disorders but no information is available for MS related fatigue. OBJECTIVE:In this study we aimed to assess fatigue symptom after five consecutive sessions of anodal tDCS applied over the motor cortex in patients with MS. METHODS:We enrolled 25 patients with MS all of whom experienced fatigue. We delivered anodal and sham tDCS in random order in two separate experimental sessions at least 1 month apart. The stimulating current was delivered for 15 minutes once a day for 5 consecutive days. In each session the Fatigue Impact Scale (FIS) and the Back Depression Inventory (BDI) were administered before the treatment (baseline), immediately after treatment on day five (T1), one week (T2) and three weeks (T3) after the last tDCS session. RESULTS:All patients tolerated tDCS well without adverse events. The fatigue score significantly decreased after anodal tDCS in 65% of the patients (responders). After patients received tDCS for 5 days their FIS scores improved by about 30% and the tDCS-induced benefits persisted at T2 and T3. CONCLUSION:Our preliminary findings suggest that anodal tDCS applied over the motor cortex, could improve fatigue in most patients with MS.
10.3233/NRE-131019
Repetitive transcranial magnetic stimulation treatment of comorbid posttraumatic stress disorder and major depression.
Rosenberg Paul B,Mehndiratta Ritula B,Mehndiratta Yash P,Wamer Angela,Rosse Richard B,Balish Marshall
The Journal of neuropsychiatry and clinical neurosciences
Twelve patients with comorbid posttraumatic stress disorder (PTSD) and major depression underwent repetitive transcranial magnetic stimulation (rTMS) to left frontal cortex as an open-label adjunct to current antidepressant medications. rTMS parameters were as follows: 90% of motor threshold, 1 Hz or 5 Hz, 6,000 stimuli over 10 days. Seventy-five percent of the patients had a clinically significant antidepressant response after rTMS, and 50% had sustained response at 2-month follow-up. Comparable improvements were seen in anxiety, hostility, and insomnia, but only minimal improvement in PTSD symptoms. Left frontal cortical rTMS may have promise for treating depression in PTSD, but there may be a dissociation between treating mood and treating core PTSD symptoms.
10.1176/jnp.14.3.270
Low intensity transcranial electric stimulation: Safety, ethical, legal regulatory and application guidelines.
Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology
Low intensity transcranial electrical stimulation (TES) in humans, encompassing transcranial direct current (tDCS), transcutaneous spinal Direct Current Stimulation (tsDCS), transcranial alternating current (tACS), and transcranial random noise (tRNS) stimulation or their combinations, appears to be safe. No serious adverse events (SAEs) have been reported so far in over 18,000 sessions administered to healthy subjects, neurological and psychiatric patients, as summarized here. Moderate adverse events (AEs), as defined by the necessity to intervene, are rare, and include skin burns with tDCS due to suboptimal electrode-skin contact. Very rarely mania or hypomania was induced in patients with depression (11 documented cases), yet a causal relationship is difficult to prove because of the low incidence rate and limited numbers of subjects in controlled trials. Mild AEs (MAEs) include headache and fatigue following stimulation as well as prickling and burning sensations occurring during tDCS at peak-to-baseline intensities of 1-2mA and during tACS at higher peak-to-peak intensities above 2mA. The prevalence of published AEs is different in studies specifically assessing AEs vs. those not assessing them, being higher in the former. AEs are frequently reported by individuals receiving placebo stimulation. The profile of AEs in terms of frequency, magnitude and type is comparable in healthy and clinical populations, and this is also the case for more vulnerable populations, such as children, elderly persons, or pregnant women. Combined interventions (e.g., co-application of drugs, electrophysiological measurements, neuroimaging) were not associated with further safety issues. Safety is established for low-intensity 'conventional' TES defined as <4mA, up to 60min duration per day. Animal studies and modeling evidence indicate that brain injury could occur at predicted current densities in the brain of 6.3-13A/m that are over an order of magnitude above those produced by tDCS in humans. Using AC stimulation fewer AEs were reported compared to DC. In specific paradigms with amplitudes of up to 10mA, frequencies in the kHz range appear to be safe. In this paper we provide structured interviews and recommend their use in future controlled studies, in particular when trying to extend the parameters applied. We also discuss recent regulatory issues, reporting practices and ethical issues. These recommendations achieved consensus in a meeting, which took place in Göttingen, Germany, on September 6-7, 2016 and were refined thereafter by email correspondence.
10.1016/j.clinph.2017.06.001
Transcranial direct current stimulation in treatment resistant depression: a randomized double-blind, placebo-controlled study.
Palm U,Schiller C,Fintescu Z,Obermeier M,Keeser D,Reisinger E,Pogarell O,Nitsche M A,Möller H-J,Padberg F
Brain stimulation
BACKGROUND:Anodal transcranial direct current stimulation (tDCS) of the prefrontal cortex has been proposed as therapeutic intervention in major depression. According to clinical needs, this study addresses the question whether tDCS is effective in treatment resistant major depressive episodes. METHODS:Twenty-two patients with a major depressive episode were randomly assigned to a cross-over protocol comparing tDCS and placebo stimulation add-on to a stable antidepressant medication. The parameters of active tDCS were: 1 or 2 mA for 20 minutes/day, anode over the left dorsolateral prefrontal cortex, cathode over the contralateral supraorbital region. Active and placebo tDCS was applied for 2 weeks using indistinguishable DC stimulators. Patients, raters, and operators were blinded to treatment conditions. RESULTS:There was no significant difference in depression scores after 2 weeks of real compared with 2 weeks of sham tDCS. Scores on the Hamilton Depression Rating Scale were reduced from baseline by 14.7% for active tDCS and 10% for placebo tDCS. In contrast, subjective mood ratings showed an increase in positive emotions after real tDCS compared with sham tDCS. CONCLUSIONS:Anodal tDCS, applied for 2 weeks, was not superior to placebo treatment in patients with treatment resistant depression. However, secondary outcome measures are pointing to a positive effect of tDCS on emotions. Therefore, modified and improved tDCS protocols should be carried out in controlled pilot trials to develop tDCS towards an efficacious antidepressant intervention in therapy-resistant depression.
10.1016/j.brs.2011.08.005
Go-no-go task performance improvement after anodal transcranial DC stimulation of the left dorsolateral prefrontal cortex in major depression.
Boggio Paulo S,Bermpohl Felix,Vergara Adriana O,Muniz Ana L C R,Nahas Fernanda H,Leme Priscila B,Rigonatti Sergio P,Fregni Felipe
Journal of affective disorders
BACKGROUND:We recently showed that repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex (DLPFC) can affect the performance in an affective go-no-go (AGN) task. We aimed to extend this previous investigation testing whether one session of anodal transcranial direct current stimulation (tDCS) of the left DLPFC, as compared with anodal occipital and sham tDCS, affects this AGN task performance. METHODS:Twenty-six patients with major depression were randomized to receive anodal tDCS of the left DLPFC, occipital cortex or sham tDCS (the cathode electrode was placed over the frontopolar area for the three conditions). An AGN task was performed immediately before and after treatment. Performance changes (pre and post-treatment) were compared across groups of treatment and correlated with Hamilton Depression Rating Scale (HDRS) score changes. RESULTS:The results show that anodal stimulation of the left DLPFC was the only condition that induced a significant improvement in task performance as shown by the increase in the number of correct responses. In addition, this effect was specific for figures with positive emotional content. This performance enhancement was not correlated with mood changes after 10 days of tDCS treatment. LIMITATIONS:Although the effects of tDCS are less focal than rTMS, it can induce a longer and stronger modulation of cortical excitability. CONCLUSIONS:Our findings suggest that left DLPFC activity is associated with positive emotional processing, confirming and extending results of previous studies that associated right DLPFC and orbito-frontal cortex activity with emotional processing. Furthermore the effects of tDCS on mood and cognition seem to be independent in major depression. These lines of evidence together shed light on the neural circuitry involved with emotional processing in major depression.
10.1016/j.jad.2006.10.026
Treatment of depression with transcranial direct current stimulation (tDCS): a review.
Nitsche Michael A,Boggio Paulo S,Fregni Felipe,Pascual-Leone Alvaro
Experimental neurology
Major Depression Disorder (MDD) is usually accompanied by alterations of cortical activity and excitability, especially in prefrontal areas. These are reflections of a dysfunction in a distributed cortico-subcortical, bihemispheric network. Therefore it is reasonable to hypothesize that altering this pathological state with techniques of brain stimulation may offer a therapeutic target. Besides repetitive transcranial magnetic stimulation, tonic stimulation with weak direct currents (tDCS) modulates cortical excitability for hours after the end of stimulation, thus, it is a promising non-invasive therapeutic option. Early studies from the 1960s suggested some efficacy of DC stimulation to reduce symptoms in depression, but mixed results and development of psychotropic drugs resulted in an early abandonment of this technique. In the last years tDCS protocols have been optimized. Application of the newly developed stimulation protocols in patients with major depression has shown promise in few pilot studies. Further studies are needed to identify the optimal parameters of stimulation and the clinical and patient characteristics that may condition response to tDCS.
10.1016/j.expneurol.2009.03.038
Reliability and validity of a new post-stroke depression scale in Chinese population.
Yue Yingying,Liu Rui,Lu Jian,Wang Xiaojing,Zhang Shining,Wu Aiqin,Wang Qiao,Yuan Yonggui
Journal of affective disorders
BACKGROUND:Nowadays there is still a lack of effective method to evaluate post-stroke depression. To distinguish patients with and without depression after stroke reliably, this study proposes a new Post-Stroke Depression Scale (PSDS). METHODS:PSDS was developed based on various depression scales and clinician experiences. 158 stroke patients who were able to finish PSDS and Hamilton Depression Rating Scale (HDRS) were recruited. Cronbach α, Spearman rank coefficient and Kruskal-Wallis test were respectively used to examine reliability, internal consistency and discriminate validity. Then the Receiver Operating Characteristic (ROC) curve was used to determine the ability of scale and categorized scales to the range of depression. Finally, the factors of the PSDS were classified by average clustering analysis. RESULTS:The Cronbach α of PSDS was 0.797 (95% CI) indicted a good reliability. The Spearman correlation coefficient between PSDS and HDRS was 0.822 (P<0.001) showed an excellent congruent validity. The discriminate validity displayed significant difference between patients with and without depression (P<0.001). 6/24 was set to be the cut-off value by ROC analysis. Moreover, the different severity was distinguished by the value 6/24, 15/24 and 17/24. LIMITATIONS:The small sample size maybe the main limitation, the larger sample used in different fields according sex, age and side-lesion was needed to verity the results. The cut off value calculated by ROC curve maybe react the severity of the disease to some extent, but it is not absolute. CONCLUSIONS:PSDS is a valid, reliable and specific tool for evaluating post-stroke depression patients and can be conveniently utilized.
10.1016/j.jad.2014.11.031
Clinical practice guidelines for post-stroke depression in China.
Zhao Fu-Ying,Yue Ying-Ying,Li Lei,Lang Sen-Yang,Wang Ming-Wei,Du Xiang-Dong,Deng Yun-Long,Wu Ai-Qin,Yuan Yong-Gui
Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)
Post-stroke depression (PSD) is a very common complication that leads to increased physical disability, poor functional outcome, and higher mortality. Therefore, early detection and treatment are very important. Since there are currently no specific guidelines for this disorder in China, the purpose of this study was to develop PSD guidelines and provide suggestions for clinicians and related workers.
10.1590/1516-4446-2017-2343
Cognitive behavioral therapy for post-stroke depression: A meta-analysis.
Wang Shi-Bin,Wang Yuan-Yuan,Zhang Qing-E,Wu Shuo-Lin,Ng Chee H,Ungvari Gabor S,Chen Liang,Wang Chun-Xue,Jia Fu-Jun,Xiang Yu-Tao
Journal of affective disorders
BACKGROUND:Cognitive behavioral therapy (CBT) has been widely used for post-stroke depression (PSD), but the findings have been inconsistent. This is a meta-analysis of randomized controlled trials (RCTs) of CBT for PSD. METHODS:Both English (PubMed, PsycINFO, Embase) and Chinese (WanFang Database, Chinese National Knowledge Infrastructure and SinoMed) databases were systematically searched. Weighted and standardized mean differences (WMDs/SMDs), and the risk ratio (RR) with their 95% confidence intervals (CIs) were calculated using the random effects model. RESULTS:Altogether 23 studies with 1,972 participants with PSD were included and analyzed. Of the 23 RCTs, 39.1% (9/23) were rated as high quality studies, while 60.9% (14/23) were rated as low quality. CBT showed positive effects on PSD compared to control groups (23 arms, SMD = -0.83, 95% CI: -1.05 to -0.60, P < 0.001). Both CBT alone (7 arms, SMD = -0.76, 95% CI: -1.22 to -0.29, P = 0.001) and CBT with antidepressants (14 arms, SMD = -0.95, 95% CI: -1.20 to -0.71, P < 0.00001) significantly improved depressive symptoms in PSD. CBT had significantly higher remission (6 arms, RR = 1.76, 95% CI: 1.37-2.25, P < 0.00001) and response rates (6 arms, RR = 1.41, 95% CI: 1.22-1.63, P < 0.00001), with improvement in anxiety, neurological functional deficits and activities of daily living. CBT effects were associated with sample size, mean age, proportion of male subjects, baseline depression score, mean CBT duration, mean number of CBT sessions, treatment duration in each session and study quality. CONCLUSION:Although this meta-analysis found positive effects of CBT on depressive symptoms in PSD, the evidence for CBT is still inconclusive due to the limitations of the included studies. Future high-quality RCTs are needed to confirm the benefits of CBT in PSD.
10.1016/j.jad.2018.04.011
Does depression after stroke negatively influence physical disability? A systematic review and meta-analysis of longitudinal studies.
Blöchl Maria,Meissner Sophie,Nestler Steffen
Journal of affective disorders
BACKGROUND:Depression after stroke is common and has been proposed to negatively affect disability by preventing optimal physical rehabilitation and recovery. However, the nature of this influence remains poorly understood. Here, we synthesise longitudinal studies to examine the hypotheses that depression after stroke (i) hampers physical rehabilitation, (ii) prevents functional improvement during recovery, and (iii) is associated with poor functional outcomes. METHODS:A systematic literature search was conducted using the databases PubMed and Web of Science. A total of 5672 studies were screened; 28 met criteria for inclusion. The quality of included studies was assessed using the Newcastle-Ottawa Scale. RESULTS:Individual studies showed no consistent effects of depression post-stroke on (i) the effectiveness of physical rehabilitation and (ii) functional improvements during recovery. In contrast, random-effects models revealed that (iii) depression after stroke was associated with an increased risk for poor long-term disability (OR: 2.16, 95% CI 1.70-2.77). Overall, the quality of studies was moderate and there was evidence for publication bias. LIMITATIONS:The number of included studies was small. There was considerable methodological heterogeneity between studies, prohibiting meta-analyses for all effects of interest. Few studies examined the influence of antidepressants. CONCLUSIONS:Depressed stroke patients are generally more disabled. However, depressed mood might not restrict improvements in physical disability during rehabilitation and recovery, although it seems to be linked to a delayed increase in the risk of poor functional outcome. High-quality evidence from longitudinal studies is needed to clarify the precise mechanisms and temporal dynamics underlying these associations.
10.1016/j.jad.2018.12.082
Management of post-stroke depression in the Middle East and North Africa: Too little is known.
Kaadan M Ihsan,Larson Mary Jo
Journal of the neurological sciences
Stroke is among the most common disabilities among adults and most stroke victims live in developing countries. However, little is known about services delivered in these countries for post-stroke depression, a common comorbidity that influences functional outcomes of stroke. In this paper, a physician from Syria reviews the literature on post-stroke depression among patients living in countries of the Middle East and North Africa region in order to examine whether current practices can be improved. Studies of prevalence were found in six of the region's countries and only four studies described interventions for stroke patients with clinical depression. The limited studies on prevalence confirmed that stroke incidence and post-stroke depression are common although diagnosed depression appears to vary depending on the economic environment of the country. Hence, additional interventions in MENA countries may be warranted to increase recognition of depression in stroke patients and to ensure health professionals are prepared to deliver appropriate services to stroke patients and their family-caregivers for depression when it occurs.
10.1016/j.jns.2017.05.026
A systematic review of rehabilitation interventions to prevent and treat depression in post-stroke aphasia.
Baker Caroline,Worrall Linda,Rose Miranda,Hudson Kyla,Ryan Brooke,O'Byrne Leana
Disability and rehabilitation
PURPOSE:Stepped psychological care is the delivery of routine assessment and interventions for psychological problems, including depression. The aim of this systematic review was to analyze and synthesize the evidence of rehabilitation interventions to prevent and treat depression in post-stroke aphasia and adapt the best evidence within a stepped psychological care framework. METHOD:Four databases were systematically searched up to March 2017: Medline, CINAHL, PsycINFO and The Cochrane Library. RESULTS:Forty-five studies met inclusion and exclusion criteria. Level of evidence, methodological quality and results were assessed. People with aphasia with mild depression may benefit from psychosocial-type treatments (based on 3 level ii studies with small to medium effect sizes). For those without depression, mood may be enhanced through participation in a range of interventions (based on 4 level ii studies; 1 level iii-3 study and 6 level iv studies). It is not clear which interventions may prevent depression in post-stroke aphasia. No evidence was found for the treatment of moderate to severe depression in post-stroke aphasia. CONCLUSIONS:This study found some interventions that may improve depression outcomes for those with mild depression or without depression in post-stroke aphasia. Future research is needed to address methodological limitations and evaluate and support the translation of stepped psychological care across the continuum. Implications for Rehabilitation Stepped psychological care after stroke is a framework with levels 1 to 4 which can be used to prevent and treat depression for people with aphasia. A range of rehabilitation interventions may be beneficial to mood at level 1 for people without clinically significant depression (e.g., goal setting and achievement, psychosocial support, communication partner training and narrative therapy). People with mild symptoms of depression may benefit from interventions at level 2 (e.g., behavioral therapy, psychosocial support and problem solving). People with moderate to severe symptoms of depression require specialist mental health/behavioral services in collaboration with stroke care at levels 3 and 4 of stepped psychological care.
10.1080/09638288.2017.1315181
[Clinical significance and possibilities of therapy of post-stroke depression].
Trusova N A,Levin O S
Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova
Depression often complicates the course of the post-stroke period, adversely affecting the functional recovery and quality of life of patients, and is associated with an increased risk of mortality. Over the recent years, the role of inflammatory processes, genetics, white matter damage, cerebrovascular reactivity disorders, changes in the level of monoamines and cortisol, impaired neuroplasticity and glutamate neurotransmission in the pathophysiological mechanisms of post-stroke depression (PSD) is increasingly discussed. Randomized clinical trials (RCTs) have shown that antidepressants are highly effective in the treatment and prevention of PSD. The action of antidepressants, in particular selective serotonin reuptake inhibitors (SSRIs), can be directed to the main pathophysiological processes of post-stroke depression. Treatment of PSD with antidepressants not only reduces the severity of depression, but also improves the functional state, rehabilitation and quality of life of patients.
10.17116/jnevro201911909260
Influence of Post-Stroke Depression on Functional Independence in Activities of Daily Living.
Ethiopian journal of health sciences
BACKGROUND:Little attention has been paid to screening of depression among stroke survivors in outpatient physiotherapy clinics. Post-stroke depression is reported to have a negative impact on functional recovery. However, the exact influence on the outcome of rehabilitation such as level of functional independence remains controversial. This study aims at ascertaining the influence of post-stroke depression on functional independence in activities of daily living. METHODS:The study is a cross sectional survey of stroke survivors attending outpatient physiotherapy clinics of the University of Nigeria Teaching Hospital (UNTH) Enugu, and the Enugu State University Teaching Hospital (ESUTH). Participants were evaluated for socio-demographic characteristics. Post-stroke depression and level of functional recovery in Activities of Daily Living were assessed using the Hamilton Depression Rating Scale and the Barthel Index respectively. Data was analyzed using SPSS version 23, with α set at 0.01. RESULTS:A total of 66 participants, 42 females and 24 males, were purposively recruited into the study. Over 80% (56) of the participant had depression, with over 50% (32) being severely depressed. Post-stroke depression was associated with less functional independence in activities of daily living (p=0.000). A significant difference was found in the level of functional independence between participants with and without depression (p=0.00). CONCLUSION:Participants with post-stroke depression have less independence in activities of daily living. A longitudinal study with a larger sample size is, however, recommended so as to improve the external validity. In the mean time, outpatient rehabilitation of depressed stroke survivors should include pharmacological and psychological components.
10.4314/ejhs.v29i1.5
Post stroke depression: The sequelae of cerebral stroke.
Das Jyotirekha,G K Rajanikant
Neuroscience and biobehavioral reviews
Post-stroke depression (PSD) is the most common mental health issue, afflicting around 33% of stroke survivors. PSD has a negative impact on the rehabilitation, recuperation of motor and cognitive deficits following stroke and significantly increases the chances of relapsing neurovascular events. It has been demonstrated that biological and psychological factors have a significant role in PSD. Numerous endeavors have been made to discover the risk factors and predictors of PSD. Screening and diagnosis also have gained attention; however, a suitable tool is yet to be developed. Medications are chosen based on their viability and reaction profile in the patients. Besides pharmacotherapy, psychotherapy treatment is also highly valued by both psychiatrists and stroke patients. Additional research is needed to examine the pathophysiology of PSD. This review attempts to highlight the existing evidence and gaps in the present knowledge of the predictors of PSD, incidence, prevalence, and etiology. Further, it also discusses the screening and diagnostic approaches, therapeutic modalities and management of PSD and the impact of pre-stroke depression on PSD.
10.1016/j.neubiorev.2018.04.005
Predictivity of Early Depressive Symptoms for Post-Stroke Depression.
The journal of nutrition, health & aging
OBJECTIVES:Depression is a frequent complication after stroke. However, little is known about the predictive value of early self-reported depressive symptoms (DS) for later development of post-stroke depression (PSD) 6 months after discharge. DESIGN:Using a prospective longitudinal design, we investigated the prevalence of DS and examined their predictive value for depressive disorders 6 months after stroke while statistically controlling major established PSD risk factors. SETTING AND PARTICIPANTS:During inpatient rehabilitation, 96 stroke patients were screened for DS. After 6 months, 71 patients were attainable for a follow-up. MEASUREMENTS:DS was assessed using the 15-item Geriatric Depression Scale (GDS-15). At follow-up a telephone interview that included the Structured Clinical Interview for Psychiatric Disorders (SCID), which is based on DSM-IV criteria, and the GDS-15 was conducted. Patients with major depression (MD) at the follow-up were considered to have PSD. RESULTS:Regression analyses were conducted to examine the influence of early DS on PSD after 6 months while controlling for age, premorbid depression, and functional and cognitive impairments. The percentage of patients who scored above the GDS-15 cut-off for clinically relevant DS increased significantly, from 37% to 44%, after 6 months. According to the SCID, 27% of stroke patients fulfilled the criteria for MD, and another 16% fulfilled those for minor depression. Logistic regression showed that DS at baseline significantly predicted PSD at follow-up (odds ratio: 1.43; 95% CI: 1.15-1.8). CONCLUSION:Self-reported DS during inpatient rehabilitation are predictive for PSD 6 months after discharge. Assessment of early DS contributes to identifying stroke patients at risk for PSD, thereby facilitating prevention and treatment.
10.1007/s12603-015-0540-x
Prevalence and predictors of post-stroke mood disorders: A meta-analysis and meta-regression of depression, anxiety and adjustment disorder.
Mitchell Alex J,Sheth Bhavisha,Gill John,Yadegarfar Motahare,Stubbs Brendon,Yadegarfar Mohammad,Meader Nick
General hospital psychiatry
OBJECTIVE:To ascertain the prevalence and predictors of mood disorders, determined by structured clinical interviews (ICD or DSM criteria) in people after stroke. METHODS:Major electronic databases were searched from inception to June 2016 for studies involving major depression (MDD), minor depression (MnD), dysthymia, adjustment disorder, any depressive disorder (any depressive disorder) and anxiety disorders. Studies were combined using both random and fixed effects meta-analysis and results were stratified as appropriate. RESULTS:Depression was examined on 147 occasions from 2days to 7years after stroke (mean 6.87months, N=33 in acute, N=43 in rehabilitation and N=69 in the community/outpatients). Across 128 analyses involving 15,573 patients assessed for major depressive disorder (MDD), the point prevalence of depression was 17.7% (95% CI=15.6% to 20.0%) 0.65 analyses involving 9720 patients determined MnD was present in 13.1% in all settings (95% CI=10.9% to 15.8%). Dysthymia was present in 3.1% (95% CI=2.1% to 5.3%), adjustment disorder in 6.9% (95% CI=4.6 to 9.7%) and anxiety in 9.8% (95% CI=5.9% to 14.8%). Any depressive disorder was present in 33.5% (95% CI=30.3% to 36.8%). The relative risk of any depressive disorder was higher following left (dominant) hemisphere stroke, aphasia, and among people with a family history and past history of mood disorders. CONCLUSION:Depression, adjustment disorder and anxiety are common after stroke. Risk factors are aphasia, dominant hemispheric lesions and past personal/family history of depression but not time since stroke.
10.1016/j.genhosppsych.2017.04.001
Association between high serum total bilirubin and post-stroke depression.
Tang Wai Kwong,Liang Huajun,Chu Winnie Chiu Wing,Mok Vincent,Ungvari Gabor S,Wong Ka Sing
Psychiatry and clinical neurosciences
AIM:High serum bilirubin predicts depression in non-stroke subjects, but it is unknown whether it also predicts post-stroke depression (PSD). This study examined the association between the risk of PSD and bilirubin level. METHODS:Six hundred and thirty-five patients with acute ischemic stroke in Hong Kong were recruited. Serum total bilirubin, alanine transaminase and alkaline phosphatase levels were measured in all patients during their hospital stay. A psychiatrist gave the Structured Clinical Interview for DSM-IV to all patients 3 months after the index stroke, with 61 patients diagnosed with PSD: 27 with major depression, 24 with minor depression and 10 with dysthymia. RESULTS:In the full sample, the 25%, 50% and 75% percentile bilirubin levels were 7.0, 10.0 and 14.0 μmol/L, respectively. Significant differences were found between the PSD and non-PSD groups in terms of bilirubin level (P = 0.006). In post-hoc comparisons, the proportion of patients with bilirubin ≥14.1 μmol/L was significantly higher in the PSD group (37.7% vs 19.7%, P = 0.001). In the final regression model, bilirubin level (≥14.1 μmol/L) remained a significant independent predictor of PSD, with an odds ratio of 2.4. CONCLUSIONS:High bilirubin level is associated with PSD. Further investigations are needed to clarify the underlying pathophysiological link between bilirubin level and PSD.
10.1111/pcn.12051
White matter hyperintensities in post-stroke depression: a case control study.
Tang W K,Chen Y K,Lu J Y,Chu Winnie C W,Mok V C T,Ungvari Gabor S,Wong K S
Journal of neurology, neurosurgery, and psychiatry
OBJECTIVE:Despite extensive research on post-stroke depression (PSD), the role of white matter hyperintensities (WMHs) in its pathogenesis remains uncertain. The aim of this study was to evaluate the relationship between WMHs and PSD in Chinese patients with first or recurrent stroke. METHODS:A cohort of 994 patients with acute ischaemic stroke admitted to the acute stroke unit of a university-affiliated regional hospital in Hong Kong was recruited. A psychiatrist administered the Structural Clinical Interview for DSM-IV to all patients and made a diagnosis of PSD 3 months after the index stroke. 78 (7.8%) patients had PSD; 78 stroke patients matched according to age and sex but without PSD served as a control group. The severity and location of WMHs were evaluated with MRI. RESULTS:In comparison with the non-PSD group, patients in the PSD group were more likely to have severe deep WMHs (12.8% vs 1.3%; p=0.009). Severe deep WMHs remained an independent predictor of PSD in the multivariate analysis with an OR of 13.8 (p=0.016). CONCLUSION:The results suggest that WMHs may play a role in the development of PSD. The importance of WMHs in the treatment and outcome of PSD warrants further investigation.
10.1136/jnnp.2009.203141
Post stroke depression and risk of stroke recurrence and mortality: A systematic review and meta-analysis.
Cai Wa,Mueller Christoph,Li Yi-Jing,Shen Wei-Dong,Stewart Robert
Ageing research reviews
BACKGROUND:Post stroke depression is a significant neuropsychiatric manifestation, predicting a range of poor outcomes. There are several studies investigating the association between post stroke depression and stroke recurrence/mortality, but results have been inconsistent. OBJECTIVE:A systematic review, meta-analysis and meta regression of observational studies assessing the association between post stroke depression and risk of stroke recurrence and mortality. METHODS:A search of Medline (via PubMed), Web of Science databases, EMBASE, Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews was conducted until August 2018. We extracted and pooled hazard ratios from observational studies that reported the risk estimates of stroke recurrence and mortality in stroke survivors with/without depression. RESULTS:The reviewed sample comprised 15 prospective cohort studies with 250,294 participants, 139,276 cases, and follow-up periods ranging from 1 to 15 years. The meta-analysis concluded a hazard ratio for post stroke depression and all-cause mortality of 1.59 (95% CI, 1.30-1.96), but research to date has been insufficient to determine the association between post stroke depression and stroke recurrence. CONCLUSION AND RELEVANCE:Post stroke depression is associated with a significantly increased risk of mortality in stroke survivors. More researches are required on the association with stroke recurrence.
10.1016/j.arr.2019.01.013
Post-Stroke Depression.
Materia socio-medica
INTRODUCTION:The depression is a common mental disorder, especially after a stroke, which further aggravates the recovery. AIM:To analyze depression within 48 hours and fifteen days after ischemic stroke in relation to gender and location (brain hemisphere and brain circulation). METHODS:We analyzed 40 patients (65.3±10.3 years), half of them were women. Mean age of women was 66.35±7.31 years and men 64.2±12.68 years (p= 0.5). Ischemic stroke was verified by computed tomography. Levels of depression were measured with self-estimated Zung's scale. On the tests, score of 50 and higher verified depression. Criteria made by Domasio were used to determine location of the IS. RESULTS:Mean value on depression scale in acute phase of ischemic stroke was 46.85 ± 8.6 and in subacute phase 43.4 ± 8 (p =0.06). In 19 (47.5%) patients (55% of women, 40% of men; p=0.3) depression was found during the first and in 10 (25%) patients (35% of women, 15 % of men; p=0.06) during the second evaluation (p<0.019). Mean value on depression in acute phase of illness in women was 49.1 ± 7.38, as well as in men 44.6 ± 9.22 (p=0.088) and in subacute phase in women 45.25 ± 8.04, as well as in men 41.5 ± 7.75 (p=0.16). Concerning location of ischemic stroke, there were no significant differences in levels of depression. CONCLUSION:Number of patients with post-stroke depression is significantly lower in subacute phase of ischemic stroke. Although the number of depressive women and their depression scores are higher, gender differences are not statistically significant. There is no correlation between post-stroke depression and location of lesion in acute and subacute phase of illness.
10.5455/msm.2019.31.31-34
Post-Stroke Depression: A Review.
Robinson Robert G,Jorge Ricardo E
The American journal of psychiatry
Poststroke depression (PSD) has been recognized by psychiatrists for more than 100 years, but controlled systematic studies did not begin until the 1970s. Meta-analyses addressing almost all major clinical issues in the field have emerged because of the relatively small number of patients included in some stroke studies. In order to build large databases, these meta-analyses have merged patients with rigorously assessed mood disorders with major depressive features with patients scoring above arbitrary cutoff points on depression rating scales, thus missing important findings such as cognitive impairment associated with major but not minor depression. Nevertheless, PSD occurs in a significant number of patients and constitutes an important complication of stroke, leading to greater disability as well as increased mortality. The most clinically important advances, however, have been in the treatment and prevention of PSD. Recent meta-analyses of randomized controlled trials for the treatment of PSD have demonstrated the efficacy of antidepressants. Similarly, randomized controlled trials for prevention of PSD have shown that antidepressants significantly decrease the incidence of PSD compared with placebo. Early antidepressant treatment of PSD appears to enhance both physical and cognitive recovery from stroke and might increase survival up to 10 years following stroke. There has also been progress in understanding the pathophysiology of PSD. Inflammatory processes might be associated with the onset of at least some depressive symptoms. In addition, genetic and epigenetic variations, white matter disease, cerebrovascular deregulation, altered neuroplasticity, and changes in glutamate neurotransmission might be relevant etiological factors. Further elucidation of the mechanism of PSD may ultimately lead to specific targeted treatments.
10.1176/appi.ajp.2015.15030363
Post-stroke depression and functional independence: a conundrum.
Brown C,Hasson H,Thyselius V,Almborg A-H
Acta neurologica Scandinavica
OBJECTIVES:People who suffer a stroke are at risk of developing post-stroke depression (PSD). Not only does this lower their quality of life but it also increases their risk of another stroke or death. This study aimed to investigate the factors associated with PSD in order to better direct rehabilitation efforts aimed at cutting the incidence of PSD. MATERIAL AND METHODS:This study was based on all patients admitted to the stroke unit of a hospital in southern Sweden from 1 October 2003 to 30 November 2005. The total number of patients involved was 181. Measures were collected at 2 ± 1 weeks after discharge from hospital, 3 ± 0.5 months after the occurrence of the stroke and 12 ± 1 months after the occurrence of the stroke. Information collected was results from the Center of Epidemiologic Studies Depression Scale and the Barthel Index together with demographic data including age, sex, time since stroke and relationship status. RESULTS:Those patients involved in the study were mainly men (58-59%) and generally those either married or cohabiting (53-57%). The age of respondents ranged from 32 to 92 years with a mean age of 74.0 (95%CI 72.37-75.63) at 2 ± 1 weeks after discharge. The Barthel Index scores ranged from 15 to 100 with means of between 88.7 and 91.7. Between 15% and 19% of the group were clinically depressed during the time frame of the study. The Barthel Index, measuring functional independence in terms of need for assistance with personal activities of daily living (P-ADL), was consistently associated with PSD. CONCLUSIONS:The differences found in levels of depression between those with lower functional independence after a stroke compared to those more independent in P-ADL, raise the possibility that attention should be paid to therapeutic rehabilitation for stroke patients to help them recover as much functional independence as possible in order to improve their quality of life and lower their chances of developing PSD.
10.1111/j.1600-0404.2011.01595.x
Treatment of Post-Stroke Depression.
Starkstein Sergio E,Hayhow Bradleigh D
Current treatment options in neurology
PURPOSE OF REVIEW:This review presents a critical appraisal of current therapeutic strategies for patients with post-stroke depression (PSD). We present the reader with the most recent evidence to support pharmacological, psychosocial, and neuromodulation interventions in PSD. We also discuss the relevance of using antidepressants and psychotherapy to prevent PSD and discuss evidence that antidepressant treatment may reduce mortality after stroke. RECENT FINDINGS:Neuroinflammation and decrease neurogenesis and plasticity may play an important role in the mechanism of PSD. The strongest predictors of PSD are stroke severity, early physical disability, and severity of loss of functioning. Nevertheless, populations at risk for PSD are yet to be identified. Recent meta-analysis examined the efficacy of pharmacotherapy and psychotherapy. There is consensus that antidepressants such as escitalopram and paroxetine produce a significantly greater response and remission rate of PSD than placebo. Randomised controlled trials (RCTs) using psychotherapy are fewer, but recent meta-analysis tend to suggest efficacy for this treatment modality. Neuromodulation using repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS), as well as novel psychosocial interventions are potentially useful treatments in need of further research. Pharmacological therapy with antidepressants and psychotherapy should be considered as first line of treatment for PSD. The most effective antidepressants are the selective serotonin reuptake inhibitors escitalopram and paroxetine, whereas cognitive behavioural therapy is the most effective psychotherapeutic intervention.
10.1007/s11940-019-0570-5
Depression in stroke patients 7 years following stroke.
Dam H
Acta psychiatrica Scandinavica
OBJECTIVE:To study the frequency of depression in stroke patients many years following stroke, most previous studies having concentrated on the first few years. METHOD:Participants of a previous study of post-stroke depression (99 stroke patients and 28 control subjects) were re-examined 7 years later. Depression was diagnosed using research diagnostic criteria. The test battery comprised the Mini Mental State Examination, the Raven Matrices A+B and Word Pair Learning. Subjective experience of changes in memory, concentration, mood, irritability and fatigue during the 7-year period was also examined. RESULTS:Twenty per cent of the stroke patients fulfilled the criteria for major or minor depression compared with 11% of the control subjects. No differences in cognitive function were found between depressed and non-depressed stroke patients. The stroke patients reported experiencing more lability of mood and irritability during the 7-year period following stroke than the control subjects. Depressed stroke patients experienced more impairment of concentration and memory function than non-depressed stroke patients. CONCLUSION:Affective symptoms are common among stroke patients 7 years following stroke.
Post-stroke depressive disorders: a follow-up study of 103 patients.
Robinson R G,Price T R
Stroke
One hundred three patients attending a stroke clinic were evaluated for post-stroke depressive disorders using repeated quantitative assessment of psychopathology during a 12 month period. Almost one-third of these patients were depressed at the time of the initial assessment and two-thirds of these depressed patients who were re-evaluated remained depressed for 7 to 8 months. The prevalence and severity of depressive disorders was significantly elevated in those patients who were between 6 months and 2 years post-stroke. Demographic variables however did not distinguish depressed and non-depressed patients, nor did type of neurological symptoms, degree of impairment in activities of daily living or global cognitive impairment. However, patients with left hemisphere brain injury were significantly more depressed than patients with right hemisphere or brain stem infarctions. Based on this work and previous studies, we have suggested a profile for patients who are at high risk for developing post stroke depressive disorders: patients with left hemisphere frontal lobe infarctions who are within 2 years of the stroke. In spite of the fact that these depressions were clinically significant, none of the patients were presently receiving treatment. Effective treatment methods for these patients need to be developed.
PsychotherapyPlus: augmentation of cognitive behavioral therapy (CBT) with prefrontal transcranial direct current stimulation (tDCS) in major depressive disorder-study design and methodology of a multicenter double-blind randomized placebo-controlled trial.
Bajbouj Malek,Aust Sabine,Spies Jan,Herrera-Melendez Ana-Lucia,Mayer Sarah V,Peters Maike,Plewnia Christian,Fallgatter Andreas J,Frase Lukas,Normann Claus,Behler Nora,Wulf Linda,Brakemeier Eva-Lotta,Padberg Frank
European archives of psychiatry and clinical neuroscience
Major Depressive Disorder (MDD) is one of the most prevalent psychiatric disorders worldwide. About 20-30% of patients do not respond to the standard psychopharmacological and/or psychotherapeutic interventions. Mounting evidence from neuroimaging studies in MDD patients reveal altered activation patterns in lateral prefrontal brain areas. Successful cognitive behavioral therapy (CBT) is associated with a recovery of these neural alterations. Moreover, it has been demonstrated that transcranial direct current stimulation (tDCS) is capable of influencing prefrontal cortex activity and cognitive functions such as working memory and emotion regulation. Thus, a clinical trial investigating the effects of an antidepressant intervention combining CBT with tDCS seems promising. The present study investigates the antidepressant efficacy of a combined CBT-tDCS intervention as compared to CBT with sham-tDCS or CBT alone. A total of 192 patients (age range 20-65 years) with MDD (Hamilton Depression Rating Scale Score ≥ 15, 21-item version) will be recruited at four study sites across Germany (Berlin, Munich, Tuebingen, and Freiburg) and randomly assigned to one of the following three treatment arms: (1) CBT + active tDCS; (2) CBT + sham-tDCS; and (3) CBT alone. All participants will attend a 6-week psychotherapeutic intervention comprising 12 sessions of CBT each lasting 100 min in a closed group setting. tDCS will be applied simultaneously with CBT. Active tDCS includes stimulation with an intensity of 2 mA for 30 min with the anode placed over F3 and the cathode over F4 according to the EEG 10-20 system, if assigned. The primary outcome measure is the change in Montgomery-Åsberg Depression Rating Scale scores from baseline to 6, 18, and 30 weeks after the first session. Participants also undergo pre- and post-treatment neuropsychological testing and functional magnetic resonance imaging (fMRI) to assess changes in prefrontal functioning and connectivity. The study investigates whether CBT can be augmented by non-invasive brain stimulation techniques such as tDCS in the treatment of MDD. It is designed as a proof-of-principle trial for the combined tDCS-CBT treatment, but also allows the investigation of the neurobiological underpinnings of the interaction between both interventions in MDD. Trial registration ClinicalTrials.gov Identifier NCT02633449.
10.1007/s00406-017-0859-x
In-hospital risk prediction for post-stroke depression: development and validation of the Post-stroke Depression Prediction Scale.
de Man-van Ginkel Janneke M,Hafsteinsdóttir Thóra B,Lindeman Eline,Ettema Roelof G A,Grobbee Diederick E,Schuurmans Marieke J
Stroke
BACKGROUND AND PURPOSE:The timely detection of post-stroke depression is complicated by a decreasing length of hospital stay. Therefore, the Post-stroke Depression Prediction Scale was developed and validated. The Post-stroke Depression Prediction Scale is a clinical prediction model for the early identification of stroke patients at increased risk for post-stroke depression. METHODS:The study included 410 consecutive stroke patients who were able to communicate adequately. Predictors were collected within the first week after stroke. Between 6 to 8 weeks after stroke, major depressive disorder was diagnosed using the Composite International Diagnostic Interview. Multivariable logistic regression models were fitted. A bootstrap-backward selection process resulted in a reduced model. Performance of the model was expressed by discrimination, calibration, and accuracy. RESULTS:The model included a medical history of depression or other psychiatric disorders, hypertension, angina pectoris, and the Barthel Index item dressing. The model had acceptable discrimination, based on an area under the receiver operating characteristic curve of 0.78 (0.72-0.85), and calibration (P value of the U-statistic, 0.96). Transforming the model to an easy-to-use risk-assessment table, the lowest risk category (sum score, <-10) showed a 2% risk of depression, which increased to 82% in the highest category (sum score, >21). CONCLUSIONS:The clinical prediction model enables clinicians to estimate the degree of the depression risk for an individual patient within the first week after stroke.
10.1161/STROKEAHA.111.000304
[Post-stroke depression: recognition and treatment interventions].
Arseniou S,Arvaniti A,Samakouri M
Psychiatrike = Psychiatriki
Depression is the most common neuropsychiatric complication of a stroke (Post Stroke DepressionPSD) and has been shown to impede the recovery and rehabilitation of these patients. Prevalence rates of PSD vary between 6% and 79%. Direct comparison between studies is limited due to their different methodology. Etiology of PSD is determined by biological and psychosocial factors. Symptoms of PSD appear in three areas: affective, somatic and cognitive. Differential diagnosis includes post-stroke fatigue and pseudo-depressive manifestations of ischemic infarctions (apathy, aprosody, athymhormia, pseudobulbar palsy). Mortality in post-stroke patients is higher than in non-depressed stroke patients and suicide ideation is observed in 6.6-11.3% of stroke patients. Selective serotonin reuptake inhibitors (SSRI) are considered as the first choice treatment of PSD. Other therapeutic approaches include cognitive and functional rehabilitation. PSD is a potentially treatable condition, yet under-diagnosed, and has a negative effect on functional recovery and survival of stroke patients.
Cerebral microbleeds and symptom severity of post-stroke depression: a magnetic resonance imaging study.
Tang W K,Chen Y K,Lu J Y,Chu Winnie C W,Mok V C T,Ungvari Gabor S,Wong K S
Journal of affective disorders
BACKGROUND:Cerebral microbleeds (CMBs) are common in stroke survivors, although their clinical significance in the development of psychiatric conditions following stroke remains unknown. This study examines the association between post-stroke depression (PSD) symptom severity and CMBs. METHODS:Amongst the 4088 patients with acute ischemic stroke who had been admitted to the acute stroke unit of a university-affiliated regional hospital in Hong Kong, between December 2004 and May 2009, 994 patients were recruited. A psychiatrist administered the Structural Clinical Interview for DSM-IV to all 994 patients and made a diagnosis of PSD three months after the index stroke. PSD symptom severity was assessed with the 15-item Geriatric Depression Scale (GDS). Seventy-eight patients were found to have PSD. The presence and location of CMBs were evaluated with magnetic resonance imaging (MRI). RESULTS:Seventy-eight patients (7.8%) had PSD. CMBs were identified in 20 PSD patients. Relative to the no-CMB group, the mean GDS score of patients with lobar CMBs was significantly higher (12.6±2.6 versus 10.4±2.5, p=0.01 after adjusting for age, sex, global cognitive functions, neurological deficits and white matter hyperintensities). LIMITATIONS:Patients with more severe stroke, those who died before the three-month follow-up and those who became depressed later were excluded, as were those unable to give their consent due to dementia or aphasia. These selection biases may limit the generalizability of the findings. CONCLUSIONS:The results suggest that lobar CMBs may contribute to PSD symptom severity. The importance of CMBs in the pathogenesis of other psychiatric disorders in stroke survivors and other patient populations warrants further investigation.
10.1016/j.jad.2010.08.007
Effects of chronic antidepressant use on neurophysiological responses to tDCS post-stroke.
Li Xin,Morton Susanne M
Neuroscience letters
BACKGROUND:Transcranial direct current stimulation (tDCS) induces neuroplastic changes in the motor cortex of healthy individuals and has become a candidate intervention to promote recovery post-stroke. However, neurophysiological effects of tDCS in stroke are poorly understood. Antidepressant medications, which are commonly prescribed post-stroke, have the potential to significantly affect cortical excitability and alter responsiveness to tDCS interventions, yet these effects have not previously been examined. OBJECTIVE/HYPOTHESIS:To examine the effects of chronic antidepressant use, tDCS, and the interaction of the two on motor cortical excitability in people with chronic stroke. Based on previous literature in nondisabled adults, we hypothesized that post-stroke, antidepressant-takers would show decreased baseline motor cortical excitability but enhanced responsiveness to anodal tDCS. METHODS:Twenty-six participants with chronic stroke (17 control, 9 antidepressant) received real and sham anodal tDCS during separate sessions at least a week apart. Motor cortical excitability was measured before and after tDCS was applied to the lesioned hemisphere primary motor cortex. We compared baseline cortical excitability and neurophysiological responses to tDCS between groups and sessions. RESULTS:Baseline motor cortical excitability was not different between control and antidepressant groups. Following anodal tDCS over the ipsilesional primary motor cortex, cortical excitability in the non-lesioned hemisphere decreased in controls, but, surprisingly, increased in antidepressant-takers. CONCLUSIONS:Chronic antidepressant use may not affect motor cortical excitability post-stroke, however it appears to reverse some of the expected effects of tDCS. Therefore future utilization of tDCS in post-stroke neurorehabilitation research should take antidepressant medication status into account.
10.1016/j.neulet.2019.134723
A systematic review of noninvasive brain stimulation for post-stroke depression.
Bucur Madalina,Papagno Costanza
Journal of affective disorders
BACKGROUND:Post-stroke depression (PSD) is among the most frequent neuropsychiatric consequences of stroke, negatively affecting the patient's functional recovery and the quality of life. While pharmacological therapy has limited efficacy and important side effects, new appropriate treatments based on specific physiological mechanisms for PSD remain to be developed. Non-invasive brain stimulation (NIBS) techniques, modulating brain plasticity, might offer valid, alternative strategies. METHODS:We systematically searched four databases: MEDLINE, PsycARTICLES, PsycINFO and Web of Science, up to December 2017, using definite keywords, to identify studies on TMS and tDCS treatment for PSD. RESULTS:Seven studies met the inclusion criteria and the results indicate that both tDCS and rTMS are safe and have very low side effects. The reported positive results, suggesting that these methods can be considered effective therapeutic options, are questionable, and a general statement about their efficacy for PSD is premature due to small sample sizes, heterogeneous methodologies, lack of uniform diagnostic criteria, and divergent data. LIMITATIONS:The selected articles suffer lack of information about quality of life and daily living performance measures; in addition, the number of randomized controlled trials is small. CONCLUSION (S):The aim of this review was to analyze current research in the clinical use of noninvasive brain stimulation (NIBS) in PSD treatment in order to verify whether there are alternative perspectives in the treatment of PSD. Given the present evidence, future research is needed to address methodological limitations and evaluate the long-term efficacy of these methods, alone and in combination with pharmacological treatment.
10.1016/j.jad.2018.05.026
Mood and cognitive effects of transcranial direct current stimulation in post-stroke depression.
Bueno Viviane F,Brunoni Andre R,Boggio Paulo S,Bensenor Isabela M,Fregni Felipe
Neurocase
Depression following stroke (PSD) affects up to 33% of patients and is associated with increased mortality. Antidepressant drugs have several side effects; therefore novel treatments are needed. Transcranial direct current stimulation (tDCS) has induced mood and cognitive gain in several neuropsychiatric conditions but has not been tested for PSD to date. Here, we report a patient with significant mood and cognitive impairment who showed marked amelioration of these symptoms following anodal stimulation (2 mA per 30 minutes per 10 days) over the left dorsolateral prefrontal cortex. We discuss the possible mechanisms of tDCS in improving PSD. This initial preliminary data is useful to encourage further controlled trials on the field.
10.1080/13554794.2010.509319
Transcranial direct current stimulation for the treatment of post-stroke depression in aphasic patients: a case series.
Valiengo Leandro,Casati Roberta,Bolognini Nadia,Lotufo Paulo A,Benseñor Isabela M,Goulart Alessandra C,Brunoni André R
Neurocase
Aphasia is a common consequence of stroke; it is estimated that about two-thirds of aphasic patients will develop depression in the first year after the stroke. Treatment of post-stroke depression (PSD) is challenging due to the adverse effects of pharmacotherapy and difficulties in evaluating clinical outcomes, including aphasia. Transcranial direct current stimulation (tDCS) is a novel treatment that may improve clinical outcomes in the traditionally pharmacotherapy-refractory PSD. Our aim was to evaluate the safety and efficacy of tDCS for patients with PSD and with aphasia. The Stroke Aphasic Depression Questionnaire (SADQ) and the Aphasic Depression Rating Scale (ADRS) were used to evaluate the severity of PSD. The diagnoses of PSD and aphasia were confirmed by a psychiatrist and a speech-language pathologist, respectively. In this open case series, patients (n = 4) received 10 sessions (once a day) of bilateral tDCS to the dorsolateral prefrontal cortex (DLPFC) and two additional sessions after two and four weeks, for a total of 12 sessions. All patients exhibited improvement in depression after tDCS, as indicated by a decrease in SADQ (47.5%) and in ADRS (65.7%). This improvement was maintained four weeks after the treatment. In this preliminary, open-label study conducted in four PSD patients with aphasia, bilateral tDCS over the DLPFC was shown to induce a substantial mood improvement; tDCS was safe and well tolerated by every patient. Stroke patients with aphasia can be safely treated for PSD with tDCS. Sham-controlled studies are necessary to evaluate this technique further.
10.1080/13554794.2015.1130231
Transcranial direct current stimulation for the treatment of post-stroke depression: results from a randomised, sham-controlled, double-blinded trial.
Valiengo Leandro C L,Goulart Alessandra C,de Oliveira Janaina F,Benseñor Isabela M,Lotufo Paulo A,Brunoni Andre R
Journal of neurology, neurosurgery, and psychiatry
BACKGROUND:Post-stroke depression is a disabling condition occurring in about one-third of patients with stroke. Pharmacological treatments have limited efficacy and important side effects. Recently, transcranial direct current stimulation (tDCS) has shown efficacy in treating depression. This study aimed to assess the efficacy and safety of tDCS for post-stroke depression. METHODS:48 antidepressant-free patients with post-stroke depression were randomised into two groups (active and sham tDCS). 12 30 min sessions of 2 mA anodal left/cathodal right dorsolateral prefrontal tDCS were administered over 6 weeks (once daily on weekdays for 2 weeks, then 1 session every other week). The primary outcome was the change in the Hamilton Depression Rating Scale (17-items) at 6 weeks. We employed a repeated-measures analysis of variance; the depression score was the dependent variable, and time and group were independent variables. In this intention-to-treat analysis, missing data were addressed according to the last observation carried forward and the mixed-model repeated-measures analysis methods. RESULTS:5 patients dropped out (two in the active group). Active tDCS was significantly superior to sham at end point (mean difference, 4.7 points; SD=9.21; p<0.001). Response and remission rates were significantly higher in the active (37.5% and 20.8%, respectively) versus the sham (4.1% and 0%, respectively) group, with a number-needed-to-treat of 3 and 5, respectively. CONCLUSIONS:This was the first controlled study to demonstrate that tDCS was safe and effective for post-stroke depression. Therefore, tDCS might be a favourable option for treating these patients. TRIAL REGISTRATION NUMBER:NCT01525524; Results.
10.1136/jnnp-2016-314075
Application of functional near-infrared spectroscopy to explore the neural mechanism of transcranial direct current stimulation for post-stroke depression.
Li Hongyu,Zhu Ning,Klomparens Eric A,Xu Shu,Wang Man,Wang Qiang,Wang Jing,Song Luping
Neurological research
: We investigated the neural mechanism of transcranial direct current stimulation (tDCS) in the treatment of post-stroke depression (PSD) using functional near-infrared spectroscopy (fNIRS). : Twenty-six patients with PSD were randomly divided into an experimental group receiving tDCS and a control group receiving sham stimulation. The anode and cathode were placed on the left and right dorsolateral prefrontal cortex (PFC). Patients underwent fNIRS before and after treatment, combined with an emotional face sex judgment task and a '1-back' working memory task to assess reaction times and relative concentration changes of oxyhemoglobin (Oxy-Hb) in the PFC. : Reaction times for faces showing positive emotions decreased after treatment in the experimental group (P < 0.05). For faces showing negative emotions, relative Oxy-Hb concentration changes in the PFC were higher after treatment (P < 0.05), but there was no significant difference between the experimental and the control group. Reaction times during the working memory task in the experimental group were shorter after treatment (P < 0.05), and there was a significant difference between the groups (P < 0.05). Relative Oxy-Hb concentration changes in the left PFC were significantly higher after treatment in the experimental group (P < 0.05), and concentration changes in the right PFC after treatment were significantly higher in the experimental than in the control group (P < 0.05). : tDCS may improve the processing of negative emotions and working memory in patients with PSD by enhancing aerobic metabolism in the PFC, thereby improving depressive symptoms.
10.1080/01616412.2019.1612539