Starkstein Sergio E, Hayhow Bradleigh D
Division of Psychiatry, School of Medicine, University of Western Australia, Fremantle Hospital T-7 UWA, Fremantle, 6959, Australia.
School of Medicine, University of Notre Dame, Fremantle, Australia.
Curr Treat Options Neurol. 2019 Jun 25;21(7):31. doi: 10.1007/s11940-019-0570-5.
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.
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.
本综述对目前中风后抑郁症（PSD）患者的治疗策略进行批判性评估。我们向读者展示支持PSD药物、心理社会和神经调节干预的最新证据。我们还讨论使用抗抑郁药和心理治疗预防PSD的相关性，并讨论抗抑郁治疗可能降低中风后死亡率的证据。
神经炎症以及神经发生和可塑性降低可能在PSD的机制中起重要作用。PSD的最强预测因素是中风严重程度、早期身体残疾和功能丧失的严重程度。然而，PSD的高危人群尚未确定。最近的荟萃分析研究了药物治疗和心理治疗的疗效。人们一致认为，艾司西酞普兰和帕罗西汀等抗抑郁药比安慰剂能产生明显更大的PSD反应和缓解率。使用心理治疗的随机对照试验（RCT）较少，但最近的荟萃分析倾向于表明这种治疗方式有效。使用重复经颅磁刺激（rTMS）或经颅直流电刺激（tDCS）的神经调节以及新的心理社会干预是需要进一步研究的潜在有用治疗方法。抗抑郁药的药物治疗和心理治疗应被视为PSD的一线治疗方法。最有效的抗抑郁药是选择性5-羟色胺再摄取抑制剂艾司西酞普兰和帕罗西汀，而认知行为疗法是最有效的心理治疗干预措施。
