Management of depression after stroke - A systematic review of pharmacological therapies
Management of depression after stroke - A systematic review of pharmacological therapies
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DOI：
10.1161/01.str.0000162391.27991.9d
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发表时间：
2005-05-01
期刊：
影响因子：
8.3
通讯作者：
House, AO
中科院分区：
文献类型：
--
作者：
Hackett, ML;Anderson, CS;House, AO
背景和目的——尽管抑郁症可能影响中风后的恢复和预后，但它经常被忽视或管理不当，并且在这种情况下抗抑郁治疗的益处存在不确定性。我们的目的是评估抗抑郁药治疗和预防中风后抑郁的有效性。方法：我们采用Cochrane方法对抗抑郁药治疗或预防中风后抑郁症和“异常情绪”的随机安慰剂对照试验进行了系统回顾。治疗对身体和其他结果的影响也被检查。结果：7项治疗试验包括615例患者，9项预防试验包括479例患者。由于各研究在研究设计、试验质量和报告方法上存在相当大的差异，我们没有汇总所有的结果数据。在治疗试验中，抗抑郁药减轻了情绪症状，但对可诊断的抑郁症没有明显的缓解作用。没有确切的证据表明抗抑郁药可以预防抑郁症或改善中风后的恢复。结论：没有足够的随机证据支持常规使用抗抑郁药来预防抑郁症或改善中风后的康复。虽然抗抑郁药可以改善中风患者的情绪，但目前还不清楚这种适度的效果在除重度抑郁症患者之外的其他患者中有多大的临床意义。迫切需要进一步的研究来更好地确定抗抑郁药在卒中管理中的作用。
Background and Purpose - Although depression may affect recovery and outcome after stroke, it is often overlooked or inadequately managed, and there is uncertainty regarding the benefits of antidepressant therapy in this setting. We aimed to assess the effectiveness of antidepressants for the treatment and prevention of depression after stroke.Methods - We undertook a systematic review using Cochrane methods of randomized placebo-controlled trials of antidepressants for the treatment or prevention of depressive illness and "abnormal mood" after stroke. Treatment effects on physical and other outcomes were also examined.Results - Outcome data were available for 7 treatment trials including 615 patients and 9 prevention trials including 479 patients. Because of the considerable variation in research design, trial quality, and method of reporting across studies, we did not pool all the outcome data. In the treatment trials, antidepressants reduced mood symptoms but had no clear effect on producing a remission of diagnosable depressive illness. There was no definitive evidence that antidepressants prevent depression or improve recovery after stroke.Conclusions - There is insufficient randomized evidence to support the routine use of antidepressants for the prevention of depression or to improve recovery from stroke. Although antidepressants may improve mood in stroke patients with depression, it is unclear how clinically significant such modest effects are in patients other than those with major depression. There is a pressing need for further research to better define the role of antidepressants in stroke management.