Effectiveness of non-pharmacological interventions for treating post-stroke depressive symptoms: Systematic review and meta-analysis of randomized controlled trials
Yejin Lee, Brian Chen, Mandy W.M. Fong, Jin‐Moo Lee, Ginger E. Nicol, Eric J. Lenze, Lisa Tabor Connor, Carolyn Baum, Alex Wong
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.