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. 2023 Jul 5;7(7):CD003437.
doi: 10.1002/14651858.CD003437.pub5.

Pharmacological, non-invasive brain stimulation and psychological interventions, and their combination, for treating depression after stroke

Sabine M Allida  1 , Cheng-Fang Hsieh  2 , Katherine Laura Cox  3 , Kulsum Patel  4 , Alison Rouncefield-Swales  4 , C Elizabeth Lightbody  4 , Allan House  5 , Maree L Hackett  4   6
Affiliations

Pharmacological, non-invasive brain stimulation and psychological interventions, and their combination, for treating depression after stroke

Sabine M Allida et al. Cochrane Database Syst Rev. .

Abstract
in English, Spanish

Background: Depression is an important morbidity associated with stroke that impacts on recovery, yet is often undetected or inadequately treated.

Objectives: To evaluate the benefits and harms of pharmacological intervention, non-invasive brain stimulation, psychological therapy, or combinations of these to treat depression after stroke.

Search methods: This is a living systematic review. We search for new evidence every two months and update the review when we identify relevant new evidence. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review. We searched the Specialised Registers of Cochrane Stroke, and Cochrane Depression Anxiety and Neurosis, CENTRAL, MEDLINE, Embase, five other databases, two clinical trials registers, reference lists and conference proceedings (February 2022). We contacted study authors.

Selection criteria: Randomised controlled trials (RCTs) comparing: 1) pharmacological interventions with placebo; 2) non-invasive brain stimulation with sham stimulation or usual care; 3) psychological therapy with usual care or attention control; 4) pharmacological intervention and psychological therapy with pharmacological intervention and usual care or attention control; 5) pharmacological intervention and non-invasive brain stimulation with pharmacological intervention and sham stimulation or usual care; 6) non-invasive brain stimulation and psychological therapy versus sham brain stimulation or usual care and psychological therapy; 7) pharmacological intervention and psychological therapy with placebo and psychological therapy; 8) pharmacological intervention and non-invasive brain stimulation with placebo and non-invasive brain stimulation; and 9) non-invasive brain stimulation and psychological therapy versus non-invasive brain stimulation and usual care or attention control, with the intention of treating depression after stroke.

Data collection and analysis: Two review authors independently selected studies, assessed risk of bias, and extracted data from included studies. We calculated mean difference (MD) or standardised mean difference (SMD) for continuous data, and risk ratio (RR) for dichotomous data, with 95% confidence intervals (CIs). We assessed heterogeneity using the I² statistic and certainty of the evidence according to GRADE.

Main results: We included 65 trials (72 comparisons) with 5831 participants. Data were available for: 1) 20 comparisons; 2) nine comparisons; 3) 25 comparisons; 4) three comparisons; 5) 14 comparisons; and 6) one comparison. We found no trials for comparisons 7 to 9. Comparison 1: Pharmacological interventions Very low-certainty evidence from eight trials suggests pharmacological interventions decreased the number of people meeting the study criteria for depression (RR 0.70, 95% CI 0.55 to 0.88; P = 0.002; 8 RCTs; 1025 participants) at end of treatment and very low-certainty evidence from six trials suggests that pharmacological interventions decreased the number of people with inadequate response to treatment (RR 0.47, 95% CI 0.32 to 0.70; P = 0.0002; 6 RCTs; 511 participants) compared to placebo. More adverse events related to the central nervous system (CNS) (RR 1.55, 95% CI 1.12 to 2.15; P = 0.008; 5 RCTs; 488 participants; very low-certainty evidence) and gastrointestinal system (RR 1.62, 95% CI 1.19 to 2.19; P = 0.002; 4 RCTs; 473 participants; very low-certainty evidence) were noted in the pharmacological intervention than in the placebo group. Comparison 2: Non-invasive brain stimulation Very low-certainty evidence from two trials show that non-invasive brain stimulation had little to no effect on the number of people meeting the study criteria for depression (RR 0.67, 95% CI 0.39 to 1.14; P = 0.14; 2 RCTs; 130 participants) and the number of people with inadequate response to treatment (RR 0.84, 95% CI 0.52, 1.37; P = 0.49; 2 RCTs; 130 participants) compared to sham stimulation. Non-invasive brain stimulation resulted in no deaths. Comparison 3: Psychological therapy Very low-certainty evidence from six trials suggests that psychological therapy decreased the number of people meeting the study criteria for depression at end of treatment (RR 0.77, 95% CI 0.62 to 0.95; P = 0.01; 521 participants) compared to usual care/attention control. No trials of psychological therapy reported on the outcome inadequate response to treatment. No differences in the number of deaths or adverse events were found in the psychological therapy group compared to the usual care/attention control group. Comparison 4: Pharmacological interventions with psychological therapy No trials of this combination reported on the primary outcomes. Combination therapy resulted in no deaths. Comparison 5: Pharmacological interventions with non-invasive brain stimulation Non-invasive brain stimulation with pharmacological intervention reduced the number of people meeting study criteria for depression at end of treatment (RR 0.77, 95% CI 0.64 to 0.91; P = 0.002; 3 RCTs; 392 participants; low-certainty evidence) but not the number of people with inadequate response to treatment (RR 0.95, 95% CI 0.69 to 1.30; P = 0.75; 3 RCTs; 392 participants; very low-certainty evidence) compared to pharmacological therapy alone. Very low-certainty evidence from five trials suggest no difference in deaths between this combination therapy (RR 1.06, 95% CI 0.27 to 4.16; P = 0.93; 487 participants) compared to pharmacological therapy intervention and sham stimulation or usual care. Comparison 6: Non-invasive brain stimulation with psychological therapy No trials of this combination reported on the primary outcomes.

Authors' conclusions: Very low-certainty evidence suggests that pharmacological, psychological and combination therapies can reduce the prevalence of depression while non-invasive brain stimulation had little to no effect on the prevalence of depression. Pharmacological intervention was associated with adverse events related to the CNS and the gastrointestinal tract. More research is required before recommendations can be made about the routine use of such treatments.

Antecedentes: La depresión tiene una morbilidad importante asociada con el accidente cerebrovascular que repercute en la recuperación, pero que a menudo no se detecta o se trata de manera inadecuada.

Objetivos: Evaluar los efectos beneficiosos y perjudiciales de las intervenciones farmacológicas, la estimulación cerebral no invasiva, la terapia psicológica o las combinaciones de éstas para tratar la depresión después del accidente cerebrovascular. MÉTODOS DE BÚSQUEDA: Esta es una revisión sistemática continua. Cada dos meses se busca nueva evidencia y la revisión se actualiza cuando se identifica evidencia nueva relevante. Consultar el estado actual de esta revisión en la Base de Datos Cochrane de Revisiones Sistemáticas (Cochrane Database of Systematic Reviews). Se realizaron búsquedas en los Registros especializados del Grupo Cochrane de Accidentes cerebrovasculares (Cochrane Stroke) y del Grupo Cochrane de Depresión, ansiedad y neurosis (Cochrane Depression, Anxiety and Neurosis), en CENTRAL, MEDLINE, Embase, otras cinco bases de datos, dos registros de ensayos clínicos, listas de referencias y resúmenes de congresos (febrero de 2022). Se estableció contacto con autores de estudios. CRITERIOS DE SELECCIÓN: Ensayos controlados aleatorizados (ECA) que compararan: 1) intervenciones farmacológicas con placebo; 2) estimulación cerebral no invasiva con estimulación simulada o atención habitual; 3) terapia psicológica con atención habitual o control de atención; 4) intervención farmacológica y terapia psicológica con intervención farmacológica y atención habitual o control de atención; 5) intervención farmacológica y estimulación cerebral no invasiva con intervención farmacológica y estimulación simulada o atención habitual; 6) estimulación cerebral no invasiva y terapia psicológica versus estimulación cerebral simulada o atención habitual y terapia psicológica; 7) intervención farmacológica y terapia psicológica con placebo y terapia psicológica; 8) intervención farmacológica y estimulación cerebral no invasiva con placebo y estimulación cerebral no invasiva; y 9) estimulación cerebral no invasiva y terapia psicológica versus estimulación cerebral no invasiva y atención habitual o control de atención, con la intención de tratar la depresión después del accidente cerebrovascular. OBTENCIÓN Y ANÁLISIS DE LOS DATOS: Dos autores de la revisión, de forma independiente, seleccionaron los estudios, evaluaron el riesgo de sesgo y extrajeron los datos de los estudios incluidos. Se calculó la diferencia de medias (DM) o la diferencia de medias estandarizada (DME) para los datos continuos, y la razón de riesgos (RR) para los datos dicotómicos, con intervalos de confianza (IC) del 95%. La heterogeneidad se evaluó mediante la estadística I² y la certeza de la evidencia según GRADE.

Resultados principales: Se incluyeron 65 ensayos (72 comparaciones) con 5831 participantes. Se dispuso de datos para: 1) 20 comparaciones; 2) nueve comparaciones; 3) 25 comparaciones; 4) tres comparaciones; 5) 14 comparaciones; y 6) una comparación. No se encontraron ensayos para las comparaciones 7 a 9. Comparación 1: Intervenciones farmacológicas Evidencia de certeza muy baja de ocho ensayos indica que las intervenciones farmacológicas disminuyeron el número de personas que cumplían los criterios del estudio para la depresión (RR 0,70; IC del 95%: 0,55 a 0,88; p = 0,002; ocho ECA; 1025 participantes) al final del tratamiento y evidencia de certeza muy baja de seis ensayos indica que las intervenciones farmacológicas disminuyeron el número de personas con respuesta inadecuada al tratamiento (RR 0,47; IC del 95%: 0,32 a 0,70; p = 0,0002; seis ECA; 511 participantes) en comparación con placebo. Se observaron más eventos adversos relacionados con el sistema nervioso central (SNC) (RR 1,55; IC del 95%: 1,12 a 2,15; p = 0,008; cinco ECA; 488 participantes; evidencia de certeza muy baja) y el sistema gastrointestinal (RR 1,62; IC del 95%: 1,19 a 2,19; p = 0,002; cuatro ECA; 473 participantes; evidencia de certeza muy baja) en el grupo de intervención farmacológica que en el grupo placebo. Comparación 2: Estimulación cerebral no invasiva Evidencia de certeza muy baja de dos ensayos muestra que la estimulación cerebral no invasiva tuvo poco o ningún efecto sobre el número de personas que cumplían los criterios del estudio para la depresión (RR 0,67; IC del 95%: 0,39 a 1,14; p = 0,14; dos ECA; 130 participantes) y el número de personas con respuesta inadecuada al tratamiento (RR 0,84; IC del 95%: 0,52 a 1,37; p = 0,49; dos ECA; 130 participantes) en comparación con la estimulación simulada. La estimulación cerebral no invasiva no provocó muertes. Comparación 3: Terapia psicológica Evidencia de certeza muy baja de seis ensayos indica que la terapia psicológica disminuyó el número de personas que cumplían los criterios del estudio para la depresión al final del tratamiento (RR 0,77; IC del 95%: 0,62 a 0,95; p = 0,01; 521 participantes) en comparación con atención habitual/control de atención. Ningún ensayo de terapia psicológica informó sobre el desenlace respuesta inadecuada al tratamiento. No se encontraron diferencias en el número de muertes o eventos adversos en el grupo de terapia psicológica en comparación con el grupo de control de atención/atención habitual. Comparación 4: Intervenciones farmacológicas con terapia psicológica Ningún ensayo de esta combinación informó sobre los desenlaces principales. El tratamiento combinado no provocó muertes. Comparación 5: Intervenciones farmacológicas con estimulación cerebral no invasiva La estimulación cerebral no invasiva con intervención farmacológica redujo el número de personas que cumplían los criterios del estudio para la depresión al final del tratamiento (RR 0,77; IC del 95%: 0,64 a 0,91; p = 0,002; tres ECA; 392 participantes; evidencia de certeza baja), pero no el número de personas con respuesta inadecuada al tratamiento (RR 0,95; IC del 95%: 0,69 a 1,30; p = 0,75; tres ECA; 392 participantes; evidencia de certeza muy baja) en comparación con el tratamiento farmacológico solo. Evidencia de certeza muy baja de cinco ensayos no indica diferencias en las muertes entre este tratamiento combinado (RR 1,06; IC del 95%: 0,27 a 4,16; p = 0,93; 487 participantes) en comparación con la intervención de tratamiento farmacológico y la estimulación simulada o la atención habitual. Comparación 6: Estimulación cerebral no invasiva con terapia psicológica Ningún ensayo de esta combinación informó sobre los desenlaces principales.

Conclusiones de los autores: Evidencia de certeza muy baja indica que los tratamientos farmacológicos, las terapias psicológicas y los tratamientos combinados pueden reducir la prevalencia de la depresión, mientras que la estimulación cerebral no invasiva tuvo poco o ningún efecto sobre la prevalencia de la depresión. Las intervenciones farmacológicas se asociaron con eventos adversos relacionados con el SNC y el sistema gastrointestinal. Se necesitan más estudios de investigación antes de poder hacer recomendaciones sobre el uso habitual de dichos tratamientos.

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Conflict of interest statement

SA: none known. KC: none known. C‐FH: none known. HL: none known. AH: none known. MH: none known.

Figures

1
1
Study flow diagram for living review update (to February 2022). Details of searches for previous versions of this review are available in those reviews
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
4
4
Funnel plot of comparison: 1 Pharmacological interventions versus placebo, outcome: 1.1 Depression: meeting study criteria for depression at end of treatment
5
5
Funnel plot of comparison: 2 Non‐invasive brain stimulation versus sham non‐invasive brain stimulation or usual care, outcome: 2.1 Depression: mean scores at end of treatment
6
6
Funnel plot of comparison: 2 Non‐invasive brain stimulation and a pharmacological intervention versus pharmacological intervention and sham stimulation or usual care, outcome: 2.1 Depression: mean scores at end of treatment
7
7
Study flow diagram for living review update (to August 2021). Details of searches for previous versions of this review are available in those reviews
1.1
1.1. Analysis
Comparison 1: Pharmacological interventions versus placebo, Outcome 1: Depression: meeting study criteria for depression at end of treatment
1.2
1.2. Analysis
Comparison 1: Pharmacological interventions versus placebo, Outcome 2: Depression: < 50% reduction in scale scores at end of treatment
1.3
1.3. Analysis
Comparison 1: Pharmacological interventions versus placebo, Outcome 3: Depression: average change in scores between baseline and end of treatment
1.4
1.4. Analysis
Comparison 1: Pharmacological interventions versus placebo, Outcome 4: Depression: mean scores at end of treatment
1.5
1.5. Analysis
Comparison 1: Pharmacological interventions versus placebo, Outcome 5: Anxiety: meeting study criteria for anxiety at end of treatment
1.6
1.6. Analysis
Comparison 1: Pharmacological interventions versus placebo, Outcome 6: Cognitive function: average change in scores between baseline and end of treatment
1.7
1.7. Analysis
Comparison 1: Pharmacological interventions versus placebo, Outcome 7: Cognitive function: mean scores at end of treatment
1.8
1.8. Analysis
Comparison 1: Pharmacological interventions versus placebo, Outcome 8: Activities of daily living: average change in scores between baseline and end of treatment
1.9
1.9. Analysis
Comparison 1: Pharmacological interventions versus placebo, Outcome 9: Activities of daily living: mean scores at end of treatment
1.10
1.10. Analysis
Comparison 1: Pharmacological interventions versus placebo, Outcome 10: Disability: average change in scores between baseline and end of treatment
1.11
1.11. Analysis
Comparison 1: Pharmacological interventions versus placebo, Outcome 11: Disability: mean scores at end of treatment
1.12
1.12. Analysis
Comparison 1: Pharmacological interventions versus placebo, Outcome 12: Neurological function: average change in scores between baseline and end of treatment
1.13
1.13. Analysis
Comparison 1: Pharmacological interventions versus placebo, Outcome 13: Neurological function: mean scores at end of treatment
1.14
1.14. Analysis
Comparison 1: Pharmacological interventions versus placebo, Outcome 14: Adverse events: death
1.15
1.15. Analysis
Comparison 1: Pharmacological interventions versus placebo, Outcome 15: Adverse events: all
1.16
1.16. Analysis
Comparison 1: Pharmacological interventions versus placebo, Outcome 16: Adverse events: leaving the study early (including death)
2.1
2.1. Analysis
Comparison 2: Non‐invasive brain stimulation versus sham non‐invasive brain stimulation and/or usual care, Outcome 1: Depression: meeting study criteria for depression at end of treatment
2.2
2.2. Analysis
Comparison 2: Non‐invasive brain stimulation versus sham non‐invasive brain stimulation and/or usual care, Outcome 2: Depression: <50% reduction in scale scores at end of treatment
2.3
2.3. Analysis
Comparison 2: Non‐invasive brain stimulation versus sham non‐invasive brain stimulation and/or usual care, Outcome 3: Depression: mean scores at end of treatment
2.4
2.4. Analysis
Comparison 2: Non‐invasive brain stimulation versus sham non‐invasive brain stimulation and/or usual care, Outcome 4: Depression: mean scores at end of follow‐up
2.5
2.5. Analysis
Comparison 2: Non‐invasive brain stimulation versus sham non‐invasive brain stimulation and/or usual care, Outcome 5: Cognitive function: mean scores at the end of follow‐up
2.6
2.6. Analysis
Comparison 2: Non‐invasive brain stimulation versus sham non‐invasive brain stimulation and/or usual care, Outcome 6: Activities of daily living: mean scores at end of treatment
2.7
2.7. Analysis
Comparison 2: Non‐invasive brain stimulation versus sham non‐invasive brain stimulation and/or usual care, Outcome 7: Activities of daily living: mean scores at the end of follow‐up
2.8
2.8. Analysis
Comparison 2: Non‐invasive brain stimulation versus sham non‐invasive brain stimulation and/or usual care, Outcome 8: Neurological function: average change in scores between baseline and end of treatment
2.9
2.9. Analysis
Comparison 2: Non‐invasive brain stimulation versus sham non‐invasive brain stimulation and/or usual care, Outcome 9: Neurological function: mean scores at end of treatment
2.10
2.10. Analysis
Comparison 2: Non‐invasive brain stimulation versus sham non‐invasive brain stimulation and/or usual care, Outcome 10: Adverse events: death
2.11
2.11. Analysis
Comparison 2: Non‐invasive brain stimulation versus sham non‐invasive brain stimulation and/or usual care, Outcome 11: Adverse events: all
2.12
2.12. Analysis
Comparison 2: Non‐invasive brain stimulation versus sham non‐invasive brain stimulation and/or usual care, Outcome 12: Adverse events: leaving the study early (including death)
3.1
3.1. Analysis
Comparison 3: Psychological therapy versus usual care and/or attention control, Outcome 1: Depression: meeting study criteria for depression at end of treatment
3.2
3.2. Analysis
Comparison 3: Psychological therapy versus usual care and/or attention control, Outcome 2: Depression: < 50% reduction in scale scores at end of treatment
3.3
3.3. Analysis
Comparison 3: Psychological therapy versus usual care and/or attention control, Outcome 3: Depression: average change in scores between baseline and end of treatment
3.4
3.4. Analysis
Comparison 3: Psychological therapy versus usual care and/or attention control, Outcome 4: Depression: mean scores at end of treatment
3.5
3.5. Analysis
Comparison 3: Psychological therapy versus usual care and/or attention control, Outcome 5: Depression: meeting study criteria for depression at end of follow‐up
3.6
3.6. Analysis
Comparison 3: Psychological therapy versus usual care and/or attention control, Outcome 6: Depression: average change in scores between baseline and end of follow‐up
3.7
3.7. Analysis
Comparison 3: Psychological therapy versus usual care and/or attention control, Outcome 7: Depression: mean scores at end of follow‐up
3.8
3.8. Analysis
Comparison 3: Psychological therapy versus usual care and/or attention control, Outcome 8: Psychological distress: average change in scores between baseline and end of treatment
3.9
3.9. Analysis
Comparison 3: Psychological therapy versus usual care and/or attention control, Outcome 9: Psychological distress: mean scores at end of treatment
3.10
3.10. Analysis
Comparison 3: Psychological therapy versus usual care and/or attention control, Outcome 10: Anxiety: meeting study criteria for anxiety at end of treatment
3.11
3.11. Analysis
Comparison 3: Psychological therapy versus usual care and/or attention control, Outcome 11: Anxiety: mean scores at end of treatment
3.12
3.12. Analysis
Comparison 3: Psychological therapy versus usual care and/or attention control, Outcome 12: Anxiety: mean scores at end of follow‐up
3.13
3.13. Analysis
Comparison 3: Psychological therapy versus usual care and/or attention control, Outcome 13: Activities of daily living: average change in scores from baseline to end of treatment
3.14
3.14. Analysis
Comparison 3: Psychological therapy versus usual care and/or attention control, Outcome 14: Activities of daily living: mean scores at end of treatment
3.15
3.15. Analysis
Comparison 3: Psychological therapy versus usual care and/or attention control, Outcome 15: Activities of daily living: mean scores at end of follow‐up
3.16
3.16. Analysis
Comparison 3: Psychological therapy versus usual care and/or attention control, Outcome 16: Disability: mean scores at end of treatment
3.17
3.17. Analysis
Comparison 3: Psychological therapy versus usual care and/or attention control, Outcome 17: Neurological function: mean scores at end of treatment
3.18
3.18. Analysis
Comparison 3: Psychological therapy versus usual care and/or attention control, Outcome 18: Adverse events: death
3.19
3.19. Analysis
Comparison 3: Psychological therapy versus usual care and/or attention control, Outcome 19: Adverse events: all
3.20
3.20. Analysis
Comparison 3: Psychological therapy versus usual care and/or attention control, Outcome 20: Adverse events: leaving the study early (including death)
4.1
4.1. Analysis
Comparison 4: Pharmacological intervention and psychological therapy (combination) versus a pharmacological intervention and usual care or attention control (single), Outcome 1: Depression: meeting study criteria for depression at end of treatment
4.2
4.2. Analysis
Comparison 4: Pharmacological intervention and psychological therapy (combination) versus a pharmacological intervention and usual care or attention control (single), Outcome 2: Depression: < 50% reduction in scale scores at end of treatment
4.3
4.3. Analysis
Comparison 4: Pharmacological intervention and psychological therapy (combination) versus a pharmacological intervention and usual care or attention control (single), Outcome 3: Depression: mean scores at end of treatment
4.4
4.4. Analysis
Comparison 4: Pharmacological intervention and psychological therapy (combination) versus a pharmacological intervention and usual care or attention control (single), Outcome 4: Anxiety: mean scores at end of treatment
4.5
4.5. Analysis
Comparison 4: Pharmacological intervention and psychological therapy (combination) versus a pharmacological intervention and usual care or attention control (single), Outcome 5: Activities of daily living: mean scores at end of treatment
4.6
4.6. Analysis
Comparison 4: Pharmacological intervention and psychological therapy (combination) versus a pharmacological intervention and usual care or attention control (single), Outcome 6: Neurological function: mean scores at end of treatment
4.7
4.7. Analysis
Comparison 4: Pharmacological intervention and psychological therapy (combination) versus a pharmacological intervention and usual care or attention control (single), Outcome 7: Adverse events: death
4.8
4.8. Analysis
Comparison 4: Pharmacological intervention and psychological therapy (combination) versus a pharmacological intervention and usual care or attention control (single), Outcome 8: Adverse events: all
4.9
4.9. Analysis
Comparison 4: Pharmacological intervention and psychological therapy (combination) versus a pharmacological intervention and usual care or attention control (single), Outcome 9: Adverse events: leaving the study early (including death)
5.1
5.1. Analysis
Comparison 5: Pharmacological intervention and non‐invasive brain stimulation (combination) versus a pharmacological intervention and sham stimulation or usual care (single), Outcome 1: Depression: meeting the criteria for depression at end of treatment
5.2
5.2. Analysis
Comparison 5: Pharmacological intervention and non‐invasive brain stimulation (combination) versus a pharmacological intervention and sham stimulation or usual care (single), Outcome 2: Depression: <50% reduction in scale scores at end of treatment
5.3
5.3. Analysis
Comparison 5: Pharmacological intervention and non‐invasive brain stimulation (combination) versus a pharmacological intervention and sham stimulation or usual care (single), Outcome 3: Depression: mean scores at end of treatment
5.4
5.4. Analysis
Comparison 5: Pharmacological intervention and non‐invasive brain stimulation (combination) versus a pharmacological intervention and sham stimulation or usual care (single), Outcome 4: Depression: mean scores at end of follow‐up
5.5
5.5. Analysis
Comparison 5: Pharmacological intervention and non‐invasive brain stimulation (combination) versus a pharmacological intervention and sham stimulation or usual care (single), Outcome 5: Cognitive function: mean scores at end of treatment
5.6
5.6. Analysis
Comparison 5: Pharmacological intervention and non‐invasive brain stimulation (combination) versus a pharmacological intervention and sham stimulation or usual care (single), Outcome 6: Activities of daily living: mean scores at end of treatment
5.7
5.7. Analysis
Comparison 5: Pharmacological intervention and non‐invasive brain stimulation (combination) versus a pharmacological intervention and sham stimulation or usual care (single), Outcome 7: Activities of daily living: mean scores at the end of follow‐up
5.8
5.8. Analysis
Comparison 5: Pharmacological intervention and non‐invasive brain stimulation (combination) versus a pharmacological intervention and sham stimulation or usual care (single), Outcome 8: Disability: mean scores at end of treatment
5.9
5.9. Analysis
Comparison 5: Pharmacological intervention and non‐invasive brain stimulation (combination) versus a pharmacological intervention and sham stimulation or usual care (single), Outcome 9: Neurological function: mean scores at end of treatment
5.10
5.10. Analysis
Comparison 5: Pharmacological intervention and non‐invasive brain stimulation (combination) versus a pharmacological intervention and sham stimulation or usual care (single), Outcome 10: Adverse events: death
5.11
5.11. Analysis
Comparison 5: Pharmacological intervention and non‐invasive brain stimulation (combination) versus a pharmacological intervention and sham stimulation or usual care (single), Outcome 11: Adverse events: all
5.12
5.12. Analysis
Comparison 5: Pharmacological intervention and non‐invasive brain stimulation (combination) versus a pharmacological intervention and sham stimulation or usual care (single), Outcome 12: Adverse events: leaving the study early (including death)
6.1
6.1. Analysis
Comparison 6: Non‐invasive brain stimulation and psychological therapy (combination) versus psychological therapy and usual care (single), Outcome 1: Depression: meeting study criteria for depression at end of treatment
6.2
6.2. Analysis
Comparison 6: Non‐invasive brain stimulation and psychological therapy (combination) versus psychological therapy and usual care (single), Outcome 2: Depression: < 50% reduction in scale scores at end of treatment
6.3
6.3. Analysis
Comparison 6: Non‐invasive brain stimulation and psychological therapy (combination) versus psychological therapy and usual care (single), Outcome 3: Depression: mean scores at end of treatment
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References

References to studies included in this review

Alexopoulos 2012 {published data only}
    1. Alexopoulos GS, Wilkins VM, Marino P, Kanellopoulos D, Reding M, Sirey JA, et al. Ecosystem focused therapy in poststroke depression: a preliminary study. International Journal of Geriatric Psychiatry 2012;27:1053-60. - PMC - PubMed
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    1. NCT00944762. Ecosystem focused therapy for treating older depressed stroke survivors. http://ClinicalTrials.gov/show/NCT00944762 (first received 23 July 2009).
Andersen 1994 {published data only}
    1. Andersen G, Vestergaard K, Lauritzen L. Effective treatment of post-stroke depression with the selective serotonin reuptake inhibitor, citalopram. Journal of Neurology 1994;241 Suppl 1:S42. - PubMed
    1. Andersen G, Vestergaard K, Lauritzen L. Effective treatment of poststroke depression with the selective serotonin reuptake inhibitor citalopram. Stroke 1994;25(6):1099-104. - PubMed
    1. Andersen G, Vestergaard K, Lauritzen L. Post-stroke depression treated with citalopram - a selective serotonin reuptake inhibitor. Canadian Journal of Neurological Sciences 1993;20(Suppl 4):S115.
    1. Andersen G, Vestergaard K, Lauritzen L. Post-stroke depression treated with citalopram a selective serotonin reuptake inhibitor. In: Proceedings of the 7th Scandinavian Meeting on Cerebrovascular Disease. Jyvaskyla, Finland, 14-17 August 1993:54.
    1. Andersen G, Vestergaard K, Lauritzen L. Post-stroke depression treated with citalopram. Acta Neurologica Scandinavica 1994;89 Suppl 155:20.
Cao 2009a {published data only}
    1. Cao WW, Yu JM, Sun SY, Sun YB, Luan L, Cai XJ, et al. Group psychotherapy in treatment of post stroke depression [团体心理治疗在脑卒中后抑郁治疗中的应用]. Chinese Mental Health Journal 2009;23(2):100-4.
Cao 2009b {published data only}
    1. Cao WW, Yu JM, Sun SY, Sun YB, Luan L, Cai XJ, et al. Group psychotherapy in treatment of post stroke depression [团体心理治疗在脑卒中后抑郁治疗中的应用]. Chinese Mental Health Journal 2009;23(2):100-4.
Chen 2005a {published data only}
    1. Chen Y-P, Mei Y-W, Sun S-G, Bao M, Yu S-C. Evaluation of frequency repetitive transcranial magnetic stimulation for post-stroke depression and neurologic impairment. Zhongguo Linchuang Kangfu 2005;9:18-9.
Cullen 2018 {published data only}
    1. Cullen B, Pownall J, Cummings J, Baylan S, Broomfield N, Haig C, et al. Positive PsychoTherapy in ABI Rehab (PoPsTAR): a pilot randomised controlled trial. Neuropsychological Rehabilitation 2018;28(1):17-33. - PubMed
Du 2005 {published data only}
    1. Du DQ, Wu YB. Living ability and cognitive function ameliorated by low frequency repetitive transcranial magnetic stimulation in patients with post-stroke depression: comparison with drug plus psychological treatment. Zhongguo Linchuang Kangfu 2005;9(16):22-3.
Fan 2010 {published data only}
    1. Fan J, He H. Effect of psychological nursing on rehabilitation of patients with post-stroke depression. Journal of Clinical and Experimental Medicine 2010;29(9):1335–8.
Fan 2014 {published data only}
    1. Fan X. Duloxetine combined with repetitive transcranial magnetic stimulation in the treatment of post stroke depression effect. Chinese Journal of Practical Nervous Disease 2014;1:102-3.
Fang 2017 {published data only}
    1. Fang Y, Mpofu E, Athanasou J. Reducing depressive or anxiety symptoms in post-stroke patients: pilot trial of a constructive integrative psychosocial intervention. International Journal of Health Sciences 2017;11(4):53-8. - PMC - PubMed
Fruehwald 2003 {published data only}
    1. Fruehwald S, Gatterbauer E, Rehak P, Baumhackl U. Early fluoxetine treatment of post-stroke depression: a three months double-blind placebo-controlled study with an open-label long-term follow up. Journal of Neurology 2003;250(3):347-51. - PubMed
Gao 2017a {published data only}
    1. Gao J, Lin M, Zhao J, Bi S, Ni Z, Shang X. Different interventions for post-ischaemic stroke depression in different time periods: a single-blind randomized controlled trial with stratification by time after stroke. Clinical Rehabilitation 2017;31(1):71-81. - PubMed
Gao 2017b {published data only}
    1. Gao J, Lin M, Zhao J, Bi S, Ni Z, Shang X. Different interventions for post-ischaemic stroke depression in different time periods: a single-blind randomized controlled trial with stratification by time after stroke. Clinical Rehabilitation 2017;31(1):71-81. - PubMed
Gu 2016 {published data only}
    1. Gu SY, Chang MC. The effects of 10-Hz repetitive transcranial magnetic stimulation on depression in chronic stroke patients. Brain Stimulation 2016;10:270-4. - PubMed
Hoffmann 2015 {published and unpublished data}
    1. ACTRN12609000741280. Evaluation of brief interventions for enhancing early emotional adjustment following stroke: a pilot randomised controlled trial. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=308355&... (first received 25 August 2009).
    1. Hoffmann T, Ownsworth T, Eames S, Shum D. Evaluation of brief interventions for enhancing early emotional adjustment following stroke: a pilot randomised controlled trial. Topics in Stroke Rehabilitation 2015;22(2):117-26. - PubMed
    1. Ownsworth T, Hoffman T, Stemm B, Evans E, Howlett J, Shum D. Early cognitive appraisals, benefit finding and emotional status after stroke: pre-intervention associations and preliminary intervention findings. Brain Impairment 2011;12:66.
Hordacre 2021 {published and unpublished data}
    1. Hordacre B, Comacchio K, Williams L, Hillier S. Repetitive transcranial magnetic stimulation for post-stroke depression: a randomised trial with neurophysiological insight. Journal of Neurology 2021;268:1474-84. - PubMed
Huang 2002 {published data only}
    1. Huang, XH. The clinical correlation study and the effect of fluoxetine intervention on poststroke depression. Chinese Journal of Clinical Rehabilitation 2002;6(15):2296-7.
Jiang 2001a {published data only}
    1. Jiang B, Lu W, Song X-W, Tan L-M, Hu Z-P. The effect of poststroke depression interventions on the recovery of neurological function. Modern Rehabilitation 2001;5(3):29-30.
Jiang 2001b {published data only}
    1. Jiang B, Lu W, Song X-W, Tan L-M, Hu Z-P. The effect of poststroke depression interventions on the recovery of neurological function. Modern Rehabilitation 2001;5(3):29-30.
Jiang 2014a {published data only}
    1. Jiang X. Effect of transcranial magnetic stimulation combined with sertraline on neurological deficits in patients with acute cerebral infarction. Chinese Journal of Practical Nervous Disease 17;21:81-3.
Jiang 2014b {published data only}
    1. Jiang X. Effect of transcranial magnetic stimulation combined with sertraline on neurological deficits in patients with acute cerebral infarction. Chinese Journal of Practical Nervous Disease 2014;17(21):81-3.
Jin 2013 {published data only}
    1. Jin H. Effect of repetitive transcranial magnetic stimulation on post stroke depression. Chinese Journal of Rehabilitation Medicine 2013;28(1):58-60.
Kerr 2018 {published data only}
    1. ACTRN12617000245392. Effects of early motivational interviewing on post-stroke depressive symptoms: a pilot randomised controlled trial of the Good Mood Intervention program. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372347 (first received 13 February 2017). - PubMed
    1. Kerr D, Mackey E, Wijeratne T, McCann T, Rhodes L. Early motivational interviewing on post-stroke depressive symptoms: the good mood intervention program-pilot RCT. International Journal of Stroke 2015;10 Suppl 3:1-84. - PubMed
    1. Kerr D, Mackey E, Wijeratne T, McCann T. Nursing early motivational interviewing on poststroke depressive symptoms: pilot randomized controlled trial of the good mood intervention program. International Journal of Stroke 2014;19:245. - PubMed
    1. Kerr D, McCann T, Mackey E, Wijeratne T. Effects of early motivational interviewing on post-stroke depressive symptoms: pilot randomised study of the Good Mood Intervention program. International Journal of Nursing Practice 2018;24:1-8. - PubMed
Kirkness 2017a {published data only}
    1. Byun, Eeeseung, Becker, Kyra J, Kohen, Ruth, Kirkness, Catherine J, Mitchell, Pamela H. Brief psychosocial intervention to address poststroke depression may also benefit fatigue and sleep-wake disturbance. Rehabilitation Nursing 2021;46(4):222-231. - PubMed
    1. Kirkness CJ, Cain KC, Becker KJ, Tirschwell DL, Buzaitis AM, Weisman PL, et al. Randomized trial of telephone versus in-person delivery of a brief psychosocial intervention in post-stroke depression. BMC Research Notes 2017;10:500. - PMC - PubMed
Kirkness 2017b {published data only}
    1. Byun, Eeeseung, Becker, Kyra J, Kohen, Ruth, Kirkness, Catherine J, Mitchell, Pamela H. Brief psychosocial intervention to address poststroke depression may also benefit fatigue and sleep-wake disturbance. Rehabilitation Nursing 2021;46(6):222-231. - PubMed
    1. Kirkness CJ, Cain KC, Becker KJ, Tirschwell DL, Buzaitis AM, Weisman PL, et al. Randomized trial of telephone versus in-person delivery of a brief psychosocial intervention in post-stroke depression. BMC Research Notes 2017;10:500. - PMC - PubMed
Kong 2007 {published data only}
    1. Kong Y, Dong WL, Liu CF. Fluoxetine for poststroke depression: a randomized placebo controlled clinical trial. Neural Regeneration Research 2007;2:162-5.
Lai 2006a {published data only}
    1. Lai J, Zeng G. The effect of using paroxetine to treat post stroke depression. Journal of Guangdong Medical College 2006;24(6):585-6.
Li 2008 {published data only}
    1. Li L, Wang S, Ge H, Chen J, Yue S, Yu M. The beneficial effects of the herbal medicine Free and Easy Wanderer Plus (FEWP) and fluoxetine on post-stroke depression. Journal of Alternative & Complementary Medicine 2008;14(7):841-6. - PubMed
Li 2009 {published data only}
    1. Li X, Lai Z. Psychological care of patients with post-stroke depression. Journal of Clinical and Experimental Medicine 2009;8:4-5.
Li 2013 {published data only}
    1. Li N, Han Y. A study of efficacy mirtazapine merge rTMS to treatment of post-stroke depression. Chinese Journal of Trauma and Disability Medicine 2013;21(6):48-50.
Li 2014 {published data only}
    1. Li L. Fluoxetine capsules combined with repetitive transcranial magnetic stimulation on depression after stroke treatment. Chinese Journal of Practical Nervous Disease 2014;17(20):105-6.
Li 2019a {published data only}
    1. Yanfang L, Yang W. Effect of early psychological nursing intervention on neuropsychological improvement of patients with poststroke depression. Shanxi Medical Journal 2019;48:2101-3.
Liang 2015 {published data only}
    1. Liang S, Wu Z. Effect of psychological nursing intervention on mental health and quality of life for stroke patients with depression and anxiety. Chinese Journal of Nod Nursing 2015;16:1912-4.
Lincoln 2003 {published data only}
    1. Flannaghan T. Cognitive behavioural psychotherapy for the treatment of depression after stroke. Unpublished 2000.
    1. Lincoln N. Pilot evaluation of cognitive behavioural treatment of depression after stroke. National Research Register 1996. - PubMed
    1. Lincoln NB, Flannaghan T. Cognitive behavioral psychotherapy for depression following stroke: a randomized controlled trial. Stroke 2003;34:111-5. - PubMed
    1. Thomas SA, Lincoln NB. Factors relating to depression after stroke. British Journal of Clinical Psychology 2006;45:49-61. - PubMed
Lipsey 1984 {published data only}
    1. Kimura M, Robinson RG, Kosier JT. Treatment of cognitive impairment after poststroke depression: a double-blind treatment trial. Stroke 2000;31:1482-6. - PubMed
    1. Kimura M, Tateno A, Robinson RG. Treatment of poststroke generalized anxiety disorder comorbid with poststroke depression: merged analysis of nortriptyline trials. American Journal of Geriatric Psychiatry 2003;11(3):320-7. - PubMed
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    1. Lipsey JR, Robinson RG. Nortriptyline for post-stroke depression. Lancet 1984;1(8380):803. - PubMed
Liu 2015 {published data only}
    1. Liu X. The effect of repetitive transcranial magnetic stimulation on the treatment of post-stroke depression. Chinese Journal of Gerontology 2015;1:5621-2.
Liu 2020 {published data only}
    1. Liu W, Ding W. Study on the efficacy and mechanism of paroxetine hydrochloride combined with repetitive transcranial magnetic stimulation in the treatment of post-stroke depression. International Journal of Clinical and Experimental Medicine 2020;13(10):7881-8.
Lu 2016 {published data only}
    1. Lu Q, Zhang H-P, Yang S-P, Zhu Z-F. Study of low frequency repetitive transcranial magnetic stimulation in the treatment of post-stroke depression. Hainan Medical Journal 2016;27(12):1963-4.
Lu 2018 {published data only}
    1. Lu X, Li M, Zhao Y. Clinical observation on the application of psychological intervention and humanistic care nursing in patients with post-stroke depression. Journal of Qiqihar University Medicine 2018;39:2066-7.
Lu 2020 {published data only}
    1. Lu T, He L, Zhang B, Wang J, Zhang L, Dong WW, et al. Percutaneous mastoid electrical stimulator improves poststroke depression and cognitive function in patients with ischaemic stroke: a prospective, randomized, double-blind, and sham controlled study. BMC 2020;20(217):1-9. - PMC - PubMed
Meng 2015 {published data only}
    1. Meng Y. Clinical study of transcranial magnetic therapy in the treatment of depression after cerebral infarction. Chinese Journal of Trauma and Disability Medicine 2015;23(5):141-2.
Mitchell 2002 {published data only}
    1. Barer D. A brief psychosocial-behavioral intervention reduced depression after stroke more than usual care: commentary. Annals of Internal Medicine 2010;152:JC3-10. - PubMed
    1. Becker KJ, Buzaitis A, Cain KC, Fruin M, Kohen R, Teri L, et al. Brief psychosocial/behavioral intervention with antidepressant reduces post-stroke depression significantly more than antidepressant alone. In: Stroke. Vol. 39. 2008:543. - PMC - PubMed
    1. Kohen R, Cain KC, Buzaitis A, Johnson V, Becker KJ, Teri L, et al. Response to psychosocial treatment in poststroke depression is associated with serotonin transporter polymorphisms. Stroke 2011;42:2068-70. - PMC - PubMed
    1. Mitchell PH, Becker KJ, Buzaitis A, Cain KC, Johnson V, Kohen R, et al. Factors associated with treatment response to combined psychosocial and antidepressant treatment of post-stroke depression (PSD). Stroke 2010;41:e235-6.
    1. Mitchell PH, Teri L, Veith R, Buzaitis A, Tirschwell D, Becker K, et al. Living well with stroke: design and methods for a randomized controlled trial of a psychosocial behavioral intervention for poststroke depression. Journal of Stroke and Cerebrovascular Diseases 2008;17(3):109-15. - PMC - PubMed
Murray 2002 {published data only}
    1. Murray V, Von Arbin M, Asberg M, Bartfai A, Berggren A, Landtblom A, et al. Double-blind placebo comparison of sertraline and placebo in stroke patients with depression. Unpublished 2003.
    1. Murray V, Von Arbin M, Bartfai A, Berggren A, Landtblom A, Lundmark J, et al. Double-blind comparison of sertraline and placebo in stroke patients with minor depression and less severe major depression. Journal of Clinical Psychiatry 2005;66(6):708-16. - PubMed
    1. Murray V, Von Arbin M, Varelius R, Olsson JE, Terent A, Samuelsson M, et al. Sertraline in poststroke depression: a controlled study. Stroke 2002;33(1):P292.
Ohtomo 1991 {published data only}
    1. Kumar V. Post-stroke depression and treatment strategies including aniracetam. International Journal of Geriatric Psychopharmacology 1999;2:40-6.
    1. Ohtomo E, Hirai S, Terashi A, Hasegawa K, Tazaki Y, Araki G, et al. Clinical evaluation of aniracetam on psychiatric symptoms related to cerebrovascular disease. Journal of Clinical Experimental Medicine 1991;156:143-87.
Ponzio 2001 {published data only}
    1. An 8-week, double-blind, placebo controlled, parallel group study to assess the efficacy and tolerability of paroxetine in patients suffering from depression following stroke. http://www.ctr.gsk.co.uk/Summary/Paroxetine/III_PAR_625.pdf;(par 625).
    1. Ponzio F, Marini G, Riva E. The efficacy of paroxetine in some kinds of "critical" patients. European Neuropsychopharmacology 2001;11 Suppl 2:S49-S50 Abstract P.1.29.
Rampello 2005 {published data only}
    1. Rampello L, Alvano A, Chiechio S, Raffaele R, Vecchio I, Malaguarnera M. An evaluation of efficacy and safety of reboxetine in elderly patients affected by "retarded" post-stroke depression: a random, placebo-controlled study. Archives of Gerontology and Geriatrics 2005;40:275-85. - PubMed
Reding 1986 {published data only}
    1. Reding MJ, Orto LA, Winter SW, Fortuna IM, Di Ponte P, McDowell FH. Antidepressant therapy after stroke: a double-blind trial. Archives of Neurology 1986;43(8):763-5. - PubMed
Robinson 2008a {published data only}
    1. Robinson RG, Jorge RE, Clarence-Smith K, Starkstein S. Double-blind treatment of apathy in patients with poststroke depression using nefiracetam. Journal of Neuropsychiatry and Clinical Neurosciences 2009;21:144-51. - PubMed
    1. Robinson RG, Jorge RE, Clarence-Smith K. Double-blind randomized treatment of poststroke depression using nefiracetam. Journal of Neuropsychiatry and Clinical Neurosciences 2008;20(2):178-84. - PubMed
Robinson 2008b {published data only}
    1. Robinson RG, Jorge RE, Clarence-Smith K, Starkstein S. Double-blind treatment of apathy in patients with poststroke depression using nefiracetam. Journal of Neuropsychiatry and Clinical Neurosciences 2009;21:144-51. - PubMed
    1. Robinson RG, Jorge RE, Clarence-Smith K. Double-blind randomized treatment of poststroke depression using nefiracetam. Journal of Neuropsychiatry and Clinical Neurosciences 2008;20(2):178-84. - PubMed
Sun 2013 {published data only}
    1. Sun H. The efficacy of repetitive transcranial magnetic stimulation in the treatment of post-stroke depression. Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease 2013;11(3):321-2.
Tao 2008 {published data only}
    1. Tao M, Yang X. Effect of psychological nursing on depressive symptoms and functional recovery of patients with stroke depression. Chinese Journal of Practical Nervous Diseases 2008;11:154.
Terachinda 2021 {published data only}
    1. Terachinda P, Tantanatip A, Piravej K, Tangwongchai S, Srioun S, Sillapachar T, et al. High frequency repetitive transcranial magnetic stimulation versus setraline in treatment of poststroke depression: a pilot study. Chulalongkorn Medical Journal 2021;65(1):71-9.
Thomas 2007 {published data only}
    1. ISRCTN56078830. Communication And Low Mood (CALM) study. https://www.isrctn.com/ISRCTN56078830 (first received 24 June 2010).
    1. ISRCTN63855912. Psychological treatment for depression in aphasic stroke patients: a randomised controlled trial. https://doi.org/10.1186/ISRCTN63855912 (first received 29 September 2006).
    1. N0192165295. CALM: communication and low mood. National Research Register (first received 23 September 2009).
    1. Thomas SA, Lincoln NB, Walker MF, Macniven J, Haworth H. Communication and low mood (CALM) study: a randomised controlled trial evaluating behaviour therapy for low mood in people with aphasia after stroke. International Journal of Stroke 2011;6 Suppl 2:27-8.
    1. Thomas SA, Walker MF, Macniven JA, Haworth H, Lincoln NB. Communication and low mood (CALM): a randomized controlled trial of behavioural therapy for stroke patients with aphasia. Clinical Rehabilitation 2012;27(5):398-408. - PMC - PubMed
Thomas 2016 {published data only}
    1. ISRCTN12715175. Behavioural activation therapy for depression after stroke. https://doi.org/10.1186/ISRCTN12715175 (first received 10 December 2014).
    1. Thomas SA, Coates E, das Nair R, Lincoln NB, Cooper C, Palmer R, et al. BEhavioural Activation therapy for Depression after Stroke (BEADS): a study protocol for a feasibility randomised controlled pilot trial of a psychological intervention for post-stroke depression. Pilot and Feasibility Studies 2016;2(45):1-12. - PMC - PubMed
    1. Thomas SA, Drummond AER, Lincoln NB, Palmer RL, das Nair R, Latimer NR, Hackney GL, Mandefield L, Walters SJ, Hatton RD, Cooper CL, Chater TF, England TJ, Callaghan P, Coates E, Sutherland KE, Eshtan SJ, Topcu G. Behavioural activation therapy for post-stroke depression: the BEADS feasibility RCT. Health Technology Assessment 2019;23(47):1-206. - PMC - PubMed
Tian 2010 {published data only}
    1. Tian Y, Ren A. Observation on the effect of psychological care on the patients anxiety and depression disorders after stroke. Journal Qilu Nursing 2010;16:6-7.
Towle 1989 {published data only}
    1. Towle D, Lincoln NB, Mayfield LM. Evaluation of social work on depression after stroke. Clinical Rehabilitation 1989;3(2):89-96.
    1. Towle D, Lincoln NB, Mayfield LM. Service provision and functional independence in depressed stroke patients and the effect of social work intervention on these. Journal of Neurology, Neurosurgery and Psychiatry 1989;52(4):519-22. - PMC - PubMed
    1. Towle D, Mayfield L, Lincoln M. Depression after stroke. Clinical Rehabilitation 1988;2:256.
Valiengo 2017 {published data only}
    1. NCT01525524. Treatment of major depressive disorder post stroke with transcranial direct current stimulation. https://clinicaltrials.gov/ct2/show/NCT01525524 (first received 3 February 2012).
    1. Valiengo LCL, Goulart AC, Oliveira JF, Benseñor IM, Lotufo PA, Brunoni AR. Transcranial direct current stimulation for the treatment of post-stroke depression: results from a randomised, sham-controlled, double-blinded trial. Journal of Neurology, Neurosurgery and Psychiatry 2017;88:170-5. - PubMed
Wang 2004a {published data only}
    1. Wang X, Song J, Mu J. The effect of psychotherapy on depression and cognitive function of patients with cerebral stroke. Chinese Mental Health Journal 2004;18:778-81.
Wang 2005 {published data only}
    1. Chen Y, Guo JJ, Zhan S, Paul NC. Treatment effects of antidepressants in patients with post-stroke depression: a meta-analysis. Annals of Pharmacotherapy 2006;40:2115-22. - PubMed
    1. Wang ZM, Wang P, You LL. Study of effects of fluoxetine in patients with post-stroke depression, a random placebo-controlled study. Chinese Journal of Practical Nervous Diseases 2005;8:80-1.
Wang 2005a {published data only}
    1. He Y, Wang X. A clinical study of paroxetine joint psychotherapy in treating poststroke depression with anxiety. Chinese Journal of Practical Nervous Diseases 2006;9(1):34-5.
    1. Wang X, He Y, Xiao CL. A clinical trial of paroxetine and psychotherapy in patients with poststroke depression and anxiety. Chinese Mental Health Journal 2005;19:564-6.
Wang 2019 {published data only}
    1. Wang Z, Cai X, Xin H. Effect of psychological counseling nursing on training mentality and quality of life of patients with post-stroke depression. Mod Diagn Treat 2019;30:2528-30.
Watkins 2007 {published and unpublished data}
    1. Deans CF, Jack CIA. Evaluation of motivational interviewing early after acute stroke: a randomized controlled trial. Clinical Rehabilitation 2006;20:731-6.
    1. Sutton C, Dickinson H, Leathley M, Hills K, Auton M, Lightbody E, et al. Motivational interviewing: altering outcome after stroke. In: 12th European Stroke Conference. Valencia, Spain, 2003 May 21-24:103.
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Wei 2021 {published data only}
    1. Wei J, Chen X, Wen C, Huang J, Fang W, Yang X, et al. Analysis of the application of “psycho-cardiology” model in nursing care of acute stroke patients with depression. American Journal of Translational Research 2021;13(7):8021-30. - PMC - PubMed
Wiart 2000 {published data only}
    1. Wiart L, Gassies TD, France B, Petit H, Debelleix D. A double-blind, placebo controlled trial to study the efficacy and tolerance of fluoxetine in the treatment of early post stroke depression. In: Proceedings of the 152nd Annual Meeting of the American Psychiatric Association. USA, Washington: American Psychiatric Association, 15-20 May 1999.
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Wu 2019 {published data only}
    1. Wu J, Li M, Liu J. Therapeutic effect of transcranial magnetic stimulation combined with cognitive therapy on post-stroke depression. International Journal of Psychiatry and Neurology 2019;8(2):13-8.
Yang 2002 {published data only}
    1. Yang J, Zhao Y, Bai S. Controlled study on antidepressant treatment of patients with post-stroke depression. Chinese Journal of Psychology 2002;16(12):871-2.
Yang 2013 {published data only}
    1. Yang M. A comparative study of high frequency repetitive transcranial magnetic stimulation in the treatment of post stroke depression. Stroke Nervous Disorders 2013;20(5):303-5.
Yang 2014a {published data only}
    1. Yang L, Liu Y, Liu, L, Qi, X, Shi W, Lu C, et al. The curative effect of different frequency repetitive transcranial magnetic stimulation on patients with depression after stroke. Chinese Journal of Practical Nervous Diseases 2014;17(22):18-20.
Yang 2014b {published data only}
    1. Yang L, Liu Y, Liu, L, Qi, X, Shi W, Lu C, et al. The curative effect of different frequency repetitive transcranial magnetic stimulation on patients with depression after stroke. Chinese Journal of Practical Nervous Diseases 2014;17(22):18-20.
Zhang 2013 {published data only}
    1. Zhang Z, Mu J, Geng G-H, Li Q, Song J-G. Effects of repetitive transcranial magnetic stimulation on depression and cognition in the treatment of post-stroke depression. Chinese Journal of Physical Medical Rehabilitation 2013;35(3):197-200.
Zhao 2004 {published data only}
    1. Zhao H-W, Zhou C-X, Su X-L, Xiao X-C, Guo Y. Effect of mental intervention on post-stroke depression and rehabilitation of neurological function. Chinese Journal of Clinical Rehabilitation 2004;8(13):2408-9.
Zheng 2016 {published data only}
    1. Zheng F. Clinical observation of ultra-low frequency transcranial magnetic stimulation in the treatment of post stroke depression. Today Nurse 2016;6:116-7.

References to studies excluded from this review

Aben 2014 {published data only}
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ACTRN12615000840583 {published data only}
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ACTRN12620001174976 {published data only}
    1. ACTRN12620001174976. Modified and tailored cognitive behavioural therapy to treat depression for stroke survivors with aphasia. https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN1262000117... (first received 18 January 2020).
Agnoli 1985 {published data only}
    1. Agnoli A, Fioravanti M, Lechner H. Efficacy of CDP-Choline in chronic cerebral vascular diseases (CCVD). In: Appia V, Kennedy EP, Nilsson BI, Galletti P, editors(s). Novel Biochemical, Pharmacological and Clinical Aspects of Cytidinediphosphocholine. New York: Elsevier, 1985:305-15.
Bai 2017 {published data only}
    1. Bai B, Yan Z, Hao Y, Zhang Z, Li G, Dekker J, et al. A randomised controlled multimodal intervention trial in patients with ischaemic stroke in Shandong, China: design and rationale. Lancet 2017;390(1):13.
Bai 2019 {published data only}
    1. Bai ZF, Wang LY. Efficacy of sertraline for post-stroke depression: A systematic review protocol of randomized controlled trial. Medicine 2019;98(16):3. - PMC - PubMed
Beauchamp 2020 {published data only}
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Bramanti 1989 {published data only}
    1. Bramanti P, Ricci RM, Di Bella P, De Luca GP, Sessa E, Di Leo M, et al. Neuropsychological and clinical evaluation after administration of TRH-T in cerebrovascular pathology [Valutazioni neuropsicologiche e cliniche dopo somminitrazione di TRH-T neila patologia cerebrovascolare]. Rassegna di Medicina Interna 1989;X(4):157-61.
Casella 1960 {published data only}
    1. Casella C, Sokolow J. A study to determine the energizing effects of iproniazid (marsilid) on a group of hemiplegics. Archives of Physical Medicine and Rehabilitation 1960;41:381-5. - PubMed
Chalmers 2019 {published data only}
    1. Chalmers C, Leathem J, Bennett S, McNaughton H, Mahawish K. The efficacy of problem solving therapy to reduce post stroke emotional distress in younger (18-65) stroke survivors. Disability Rehabilitation 2019;41(7):753-62. - PubMed
Chang 2011 {published data only}
    1. Chang K, Zhang H, Xia Y, Chen C. Testing the effectiveness of knowledge and behavior therapy in patients of hemiplegic stroke. Topics in Stroke Rehabilitation 2011;18(5):525-35. - PubMed
Chen 2019 {published data only}
    1. Chen L, Wang F, Lv L, Zhang Y, Shen X. The efficacy of a patient-centered self-management empowerment intervention program (PCSMEI) for first-time stroke survivors: a randomized controlled trial. Stroke 2019;50 Suppl 1:AWP186.
Cheng 2016 {published data only}
    1. Cheng HY. The effect of a psychoeducational intervention on stroke family caregivers' outcomes and stroke survivors' utilisation of health and social services. Dissertation Abstracts International: Section B: The Sciences and Engineering 2016;76.
Cheng 2020 {published data only}
    1. Cheng C, Fan W, Liu C, Liu Y, Liu X. Reminiscence therapy based care program relieves post-stroke cognitive impairment, anxiety, and depression in acute ischemic stroke patients: a randomized, controlled study. Irish Journal of Medical Science 2021;190(1):345-55. - PubMed
ChiCTR1800016101 {published data only}
    1. ChiCTR1800016101. The effectiveness and cost-effectiveness of a virtual multidisciplinary stroke care clinic for community-dwelling stroke survivors and caregivers: a randomised controlled trial. https://www.chictr.org.cn/showprojen.aspx?proj=27387 (first received 5 November 2018).
ChiCTR1800017752 {published data only}
    1. ChiCTR1800017752. Exploring clinical efficacy evaluation of psychological and physical rehabilitation on post-stroke patients: a Zelen's design study. https://www.chictr.org.cn/showproj.aspx?proj=26300 (first received 12 August 2018).
ChiCTR1800019366 {published data only}
    1. ChiCTR1800019366. Escitalopram in 8-week open-label treatment of post-stroke depression: the efficacy, safety and the effect on regional brain function. https://www.chictr.org.cn/showproj.aspx?proj=32490 (first received 7 November 2018).
ChiCTR1900021168 {published data only}
    1. ChiCTR1900021168. Resting state EEG predicts the efficacy of rTMS treatment regimen for post-stroke depression. https://www.chictr.org.cn/showproj.aspx?proj=35725 (first received 31 January 2019).
ChiCTR1900026358 {published data only}
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ChiCTR2000029450 {published data only}
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ChiCTR2000029554 {published data only}
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ChiCTR2000035588 {published data only}
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Wang 2003 {published data only}
    1. Wang F, Dong X, Pan Y. Effect of yukangning in the treatment of post stroke depression and nerve function recovery. www.zglckf.com 2003;7(7):1225.
Wang 2009 {published data only}
    1. Wang P. Influence of magnetic stimulation to treat post stroke depression on recovery of neurological function. Chinese Nursing Research 2009;23(5):1356-7.
Wang 2020 {published data only}
    1. Wang XY, Li JY, Wang CW, Lv JQ. The effects of mindfulness-based intervention on quality of life and poststroke depression in patients with spontaneous intracerebral hemorrhage in China. International Journal of Geriatric Psychiatry 2020;35(5):572-80. - PubMed
Wu 2012 {published data only}
    1. Wu DY, Guo M, Gao YS, Kang YH, Guo JC, Jiang XL. Clinical effects of comprehensive therapy of early psychological intervention and rehabilitation training on neurological rehabilitation of patients with acute stroke. Asian Pacific Journal Tropical Medicine 2012;5:914-6. - PubMed
Xie 2005 {published data only}
    1. Xie R M, Liu JY, Quan HB, Wang DS, Luo M. A prospective random clinical contrast study of treatment with sertraline in elderly patients with post-stroke depression. Chinese Journal of Clinical Neurosciences 2005;13:294-7.
Xu 2010 {published data only}
    1. Xu H, Cao N, Xu D. Effect of cognitive behavioral psychological nursing on rehabilitation of post-stroke depression. Chinese Journal of Practical Nervous Diseases 2010;13:13-4.
Yao 2021 {published data only}
    1. Yao X-W, Yu Z-J, Mo C-Y, Pan H-S, Li C-Y, Li Y-L. The efficacy and safety of agomelatine, sertraline, and escitalopram for senile post-stroke depression: a randomized double-blind placebo-controlled trial. Clinical Neurology and Neurosurgery 2021;205:1-6. - PubMed
Ye 2004 {published data only}
    1. Ye LX, Wang H, Wang YD, Zhang L, Liang DS, Guo Y. Effect of anti-depressive therapy on the rehabilitation of psychological and neurological function after stroke. Chinese Journal of Cliical Rehabilitation 2004;8(31):6826-8.
Yu 2021 {published data only}
    1. Yu F, He R. The effect of fluoxetine combined with repetitive transcranial magnetic stimulation on the psychological emotions and cognitive and neurological functions of acute post-stroke depression patients. American Journal of Translational Research 2021;13(10):11883-9. - PMC - PubMed
Zhang 2013a {published data only}
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Zhou 2004 {published data only}
    1. Zhou CX, Su XL, Yang XZ, Xiao XC. Effect of psychological nursing on the rehabilitation of post-stroke depression. Chinese Journal of Clinical Rehabilitation 2004;8:3008-9.

References to studies awaiting assessment

Chen 2002a {published data only}
    1. Chen W, Wang GF, Chen XH, Sheng YL, Zhu H. Effects of paroxetine on function recovery in patients with poststroke depression. Chinese Journal of Clinical Rehabilitation 2002;6(13):2014-5.
Chen 2002b {published data only}
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Ding 2005 {published data only}
    1. Ding D, Zhang Z. Combination of paroxetine and psychotherapy in the treatment of post-stroke depression. Shanghai Archives of Psychiatry 2005;17(2):89-91.
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    1. Finkenzeller W, Zobel I, Rietz S, Schramm E, Berger M. Interpersonal psychotherapy and pharmacotherapy in post-stroke depression [Interpersonelle Psychotherapie und Pharmakotherapie bei Post-Stroke-Depression]. Nervenarzt 2009;80:805-12. - PubMed
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He 2003 {published data only}
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He 2005 {published data only}
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Huang 2005 {published data only}
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IRCT201008214607N1 {published data only}
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Katz 1998 {published data only}
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Kuriakose 2020 {published data only}
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Latow 1983 {published data only}
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Lee 2005 {published data only}
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Li 2019 {published data only}
    1. Li JM, Dai JQ, Tan YY, Gu JW. Effect of antidepressant therapy on neurological rehabilitation and neuron-specific enolase in elderly patients with post-stroke depression. Journal of the American Geriatrics Society 2019;67:S636.
Liu 2010 {published data only}
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Pearson 2005 {published data only}
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Razazian 2016 {published data only}
    1. Razazian N, Esmaeili O, Almasi A. Effect of fluoxetine on motor improvement in ischemic stroke patients: a double blind clinical trial study. Zahedan Journal of Research in Medical Sciences 2016;18(7):e7549.
Tang 2002 {published data only}
    1. Tang LY, Ye JH. Cognitive therapy on depression and cognitive dysfunction after stroke. Nursing Journal of Chinese People's Liberation Army 2002;19(4):6-7.
Wang 2015 {published data only}
    1. Wang J, Zhang M, Xu L. The clinical observation of post-stroke depression improvement by repetitive transcranial magnetic stimulation. Chinese Journal of Rehabilitation 2015;6(30):167-70.
Yan 2010a {published data only}
    1. Yan TT, He LM, Gu ZT. A randomized, controlled study of high- and low-frequency rTMS on the treatment outcome for post stroke depression [高频及低频重复经颅磁剌激对脑卒中后抑郁的疗效对比研究]. Qingdao Yiyao Weisheng 2010;42(2):81-5.
Yan 2010b {published data only}
    1. Yan TT, He LM, Gu ZT. A randomized, controlled study of high- and low-frequency rTMS on the treatment outcome for post stroke depression [高频及低频重复经颅磁剌激对脑卒中后抑郁的疗效对比研究]. Qingdao Yiyao Weisheng 2010;42(2):81-5.
Yan 2010c {published data only}
    1. Yan TT, He LM, Gu ZT. A randomized, controlled study of high- and low-frequency rTMS on the treatment outcome for post stroke depression [[高频及低频重复经颅磁剌激对脑卒中后抑郁的疗效对比研究]]. Qingdao Yiyao Weisheng 2010;42(2):81-5.
Yan 2010d {published data only}
    1. Yan TT, He LM, Gu ZT. A randomized, controlled study of high- and low-frequency rTMS on the treatment outcome for post stroke depression [高频及低频重复经颅磁剌激对脑卒中后抑郁的疗效对比研究]. Qingdao Yiyao Weisheng 2010;42(2):81-5.
Yu 2019 {published data only}
    1. Yu H-L, Cao D-X, Liu J. Effect of a novel designed intensive patient care program on cognitiveimpairment, anxiety, depression as well as relapse free survival in acuteischemic stroke patients: a randomized controlled study. Neurological Research 2019;41(9):857-866. - PubMed
Zhang 2021 {published data only}
    1. Zhang W, Li G, Song S. Study on the effect of rehabilitation nursing on patients with cerebra ischemic stroke. International Journal of Clinical and Experimental Medicine 2021;14(5):1943-9.

References to ongoing studies

ACTRN12620000165987 {published data only}
    1. ACTRN12620000165987. Examining the efficacy of an online cognitive behaviour therapy (CBT) - based self-management program for adults with neurological disorders. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379054&... (first received 31 January 2020).
ChiCTR1800020468 {published data only}
    1. ChiCTR1800020468. Therapeutic effect of high frequency repetitive transcranial magnetic stimulation with different frequencies on patients with post-stroke depression. https://www.chictr.org.cn/showprojen.aspx?proj=33127 (first received 31 December 2018).
ChiCTR1900024245 {published data only}
    1. ChiCTR1900024245. The effect of repeated transcranial magnetic stimulation on post-stroke depression and the and mechanism research by functional MRI. https://www.chictr.org.cn/showproj.aspx?proj=39878 (first received 7 February 2019).
ChiCTR1900025440 {published data only}
    1. ChiCTR1900025440. Effects of transcranial direct current stimulation for the treatment of post-stroke depression. https://www.chictr.org.cn/showproj.aspx?proj=42559 (first received 26 August 2019).
ChiCTR1900027686 {published data only}
    1. ChiCTR1900027686. The effect and mechanism of intermittent theta burst stimulation on post-stroke depression. https://www.chictr.org.cn/showproj.aspx?proj=45960 (first received 23 November 2019).
ChiCTR2000029809 {published data only}
    1. ChiCTR2000029809. Cognitive effects of electrical current therapy in post-stroke depression: a study protocol for a randomized controlled trial. https://www.chictr.org.cn/showproj.aspx?proj=38853 (first received 14 February 2020).
ChiCTR2000035582 {published data only}
    1. ChiCTR2000035582. Clinical study of low intensity ultrasound nerve stimulation in the treatment of post-stroke anxiety and depression. https://www.chictr.org.cn/historyversionpub.aspx?regno=ChiCTR2000035582 (first received 17 August 2020).
ChiCTR2100041707 {published data only}
    1. ChiCTR2100041707. Effects of rTMS on depressive state and motor function in patients with subthreshold depression after stroke. https://trialsearch.who.int/Trial2.aspx?TrialID=ChiCTR2100041707 (first received 1 January 2021).
Ding 2021 {published data only}
    1. Ding C, Xu M, Gao L, Wang X, Xu W, Guo M, et al. Clinical efficacy of Danzhi Xiaoyao Powder in the treatment of post-stroke depression: a protocol for randomized, double-blind clinical study. Medicine 2021;100(42):e27318. - PMC - PubMed
IRCT20090716002195N3 {published data only}
    1. IRCT20090716002195N3. Efficacy of mindfulness-based intervention and transcranial direct current stimulation (TDCS) on cognitive disorders, and emotional problems in patients with stroke: a randomized clinical trial. https://trialsearch.who.int/Trial2.aspx?TrialID=IRCT20090716002195N3 (first received 31 July 2019).
IRCT2017030921965N4 {published data only}
    1. IRCT2017030921965N4. Clinical trial to evaluate the efficacy of electrical stimulation of the brain with direct electrical current on depression after stroke. https://en.irct.ir/trial/19078 (first received 28 May 2017).
Kirkevold 2018 {published data only}
    1. Kirkevold M, Bragstad LK, Bronken BA, Kvigne K, Martinsen R, Hjelle EG, et al. Promoting psychosocial well-being following stroke: study protocol for a randomized, controlled trial. BMC Psychology 2018;6(12):1-12. - PMC - PubMed
NCT03056287 {published data only}
    1. NCT03056287. Exercise and brain stimulation for post-stroke. https://clinicaltrials.gov/ct2/show/NCT03056287 (first received 17 February 2017).
NCT03645759 {published data only}
    1. NCT03645759. Improving quality of life for veterans with stroke and psychological distress. https://clinicaltrials.gov/ct2/show/NCT03645759 (first received 24 August 2018).
NCT04941482 {published data only}
    1. NCT04941482. Intervention effectiveness towards improving physical and mental health for post-stroke patients. https://clinicaltrials.gov/ct2/show/NCT04941482 (first received 28 June 2021).
NCT04985838 {published data only}
    1. NCT04985838. Helping Ease Anxiety and Depression following Stroke stage 3 (HEADS:UP). https://clinicaltrials.gov/ct2/show/NCT04985838 (first received 2 August 2021).
NCT05097040 {published data only}
    1. NCT05097040. A coach-guided online acceptance and commitment therapy (ACT) intervention for stroke survivors. https://ClinicalTrials.gov/show/NCT05097040 (first received 27 October 2021).
Tang 2017 {published data only}
    1. Tang Y, Chen A, Zhu S, Yang L, Zhou J, Pan S, et al. Repetitive transcranial magnetic stimulation for depression after basal ganglia ischaemic stroke: protocol for a multicentre randomised double-blind placebo-controlled trial. BMJ Open 2017;8:1-7. - PMC - PubMed
Xu 2016 {published data only}
    1. Xu SM, Zou DZ, Shen LY, Zhou XY, Pu JC, Dong MX, et al. Efficacy and feasibility of antidepressant treatment in patients with post-stroke depression. Medicine 2016;95(45):e5349. - PMC - PubMed

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