Effectiveness of non-pharmacological interventions for treating post-stroke depressive symptoms: Systematic review and meta-analysis of randomized controlled trials

ABSTRACT

Objective

To compare the effectiveness of non-pharmacological interventions on depressive symptoms in people after stroke.

Data Sources

A literature search was performed through databases from January 2000 to August 2018: MEDLINE; CINAHL Plus; Scopus; Academic Search Complete; Cochrane Central Register of Controlled Trials; Scopus; and Library, Information Science and Technology Abstracts. Search terms included depression, stroke, non-pharmacologic, and intervention.

Study Selection

We included randomized controlled trials comparing non-pharmacological interventions to controls for depressive symptoms in people after stroke. Of 1703 identified articles, 22 trials were included in narrative synthesis, of which 13 were eligible for meta-analysis.

Data Extraction

Two reviewers extracted characteristics of participants, interventions, and results from all included trials.

Data Synthesis

Thirteen interventions were categorized into four types: complementary and alternative therapy (five trials, n=228), exercise (four trials, n=263), psychosocial therapy (two trials, n=216), and multifactorial therapy (two trials, n=358). Overall beneficial effects of non-pharmacological interventions on depressive symptoms were found both post-intervention (effect size [ES] = -0.24, 95% confidence Interval [CI]: -0.37 to -0.11, p < 0.05) and at follow-up (ES = -0.22, CI: -0.36 to -0.07, p< 0.05). We found individual beneficial effects for complementary and alternative therapy (ES = -0.29, CI: -0.55 to -0.02, p < 0.05) and psychosocial therapy (ES = - 0.33, CI: -0.60 to -0.06, p < 0.05) post-intervention.

Conclusions

Complementary and alternative therapy and psychosocial therapy appear to be promising strategies for improving post-stroke depression. Future studies target  a personalized approach for people with specific conditions such as cognitive impairment.

KEYWORDS:

• Non-pharmacological interventions
• stroke
• depression
• meta-analysis
• neuropsychiatry
• behavior therapy
• complementary therapies
• systematic review
• psychosocial therapy

Acknowledgments

The contents of this article do not necessarily represent the policies of the funding agency. We would like to thank Megen Devine at Washington University School of Medicine for her editorial assistance with this manuscript.

Author contributions

AW and YL had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. AW, MF, JL, GN, and EL contributed to the conception and design of the study. YL and BC performed literature searches, organized the database, and performed reviews and statistical analyses. YL, BC, MF, and AW interpreted the data. YL and BC wrote the first draft of the manuscript. YL, BC, MF, JL, GN, EL, LC, CB, and AW contributed to critical revision of the manuscript for important intellectual content and approved the submitted version. AW obtained funding. LC and CB provided technical and material support. MF and AW provided supervision.

AW reported grants from the National Institutes of Health (NIH) during the conduct of the study; grants from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), and Craig H. Neilsen Foundation outside of the submitted work.

JL reported grants from the NIH outside of the submitted work.

GN reported grants from the NIH, Washington University Center for Diabetes Translational Research & Institute for Clinical Translational Science, Alkermes, and Otuska American, Inc. She also serves as a consultant for Sunovion, Alkermes, and Supernus Pharmaceuticals, Patient-Centered Outcomes Research Institute, McKnight Brain Research Foundation, Taylor Family Institute for Innovative Psychiatric Research, Barnes Jewish Foundation, MagStim, Takeda, Johnson & Johnson, and Lundbeck outside of the submitted work; grants and personal fees from Janssen, and personal fees from Jazz Pharmaceuticals outside of the submitted work.

EL reported grants from the NIH, US Food and Drug Administration, Patient-Centered Outcomes Research Institute, McKnight Brain Research Foundation, Taylor Family Institute for Innovative Psychiatric Research, Barnes Jewish Foundation, Takeda, Alkermes, Aptinyx, Johnson & Johnson, and Lundbeck outside of the submitted work; grants and personal fees from Janssen, and personal fees from Jazz Pharmaceuticals outside of the submitted work.

CB reported grants from the National Center for Advancing Translational Sciences and Schultz Family Support Fund outside of the submitted work.

YL, BC, MF, and LC reported the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

No other disclosures were reported.

Additional information

Funding

This study was supported by the National Institutes of Health [K01HD095388]; National Institutes of Health [P2CHD065702].