Role of citicoline and choline in the treatment of post-stroke depression: an exploratory study

Objective To compare selective serotonin reuptake inhibitors (SSRIs) and nootropic drugs in the reduction of anxiety and depressive symptoms in post-stroke patients. Methods This retrospective cohort study included patients diagnosed with post-stroke depression that were treated with either SSRIs or nootropic drugs (i.e. citicoline or choline alphoscerate). Depression and anxiety were assessed using the Hamilton Rating Scales. Statistical associations between the use of nootropic drugs and mood disorder improvements were determined by measuring assessment scores at 6-months. Results A total of 44 post-stroke patients with depression (aged 45–75 years) were enrolled in the study: 20 were treated with SSRIs and 24 received nootropic drugs. From baseline to follow-up, the SSRI group showed a large effect size with regard depression (success rate difference [SRD] 0.57; 95% confidence interval [CI] 0.21, 0.79) and anxiety (SRD 0.49; 95% CI 0.14, 0.74), whereas the nootropic group showed a small effect size for depression (SRD 0.16; 95% CI –0.17, 0.46) and a small effect size for anxiety (SRD 0.36; 95% CI –0.03, 0.62). Conclusion The administration of nootropic drugs could be a valid therapeutic strategy to manage post-stroke patients suffering from mild–moderate anxiety or anxious-depressive syndrome, but this requires further research.

Download Full-text

Role of functional pharmacological therapy in post-stroke depression: a narrative review

Journal of International Medical Research ◽

10.1177/0300060520950557 ◽

2020 ◽

Vol 48 (10) ◽

pp. 030006052095055

Author(s):

Francesco Corallo ◽

Chiara Scarfì ◽

Francesca Antonia Arcadi ◽

Caterina Formica ◽

Marcella Di Cara ◽

...

Keyword(s):

Selective Serotonin Reuptake Inhibitors ◽

Cerebrovascular Diseases ◽

Pharmacological Therapy ◽

Narrative Review ◽

Antidepressant Therapy ◽

Exclusion Criteria ◽

Post Stroke ◽

Antidepressant Effects ◽

Post Stroke Depression

Objective We conducted a narrative review to investigate whether antidepressant therapy, including the use of selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) or the use of supportive drugs (i.e., citicoline or choline alfoscerate) as a substitute for antidepressant therapy, reduces depression in patients with cerebrovascular diseases. Methods A systematic search of the PubMed and Web of Science databases was performed, including review articles and other studies to identify additional citations. Only 4 of 1566 publications met the inclusion/exclusion criteria and were selected. Results Studies showed that post-stroke depression (PSD) could be treated with antidepressant therapy, as well as supportive drugs such as citicoline or choline alfoscerate, which may have antidepressant effects. Conclusions The findings support the efficacy of citicoline as a treatment for depression. Studies aimed to discover the characteristics of these psychostimulants in relation to PSD treatment should be performed.

Download Full-text

Oxidative Stress and Post-Stroke Depression: Possible Therapeutic Role of Polyphenols?

Current Medicinal Chemistry ◽

10.2174/0929867321666141106122319 ◽

2014 ◽

Vol 22 (3) ◽

pp. 343-351 ◽

Cited By ~ 29

Author(s):

Seyed Nabavi ◽

Olivia Dean ◽

Alyna Turner ◽

Antoni Sureda ◽

Maria Daglia ◽

...

Keyword(s):

Oxidative Stress ◽

Therapeutic Role ◽

Post Stroke ◽

Post Stroke Depression

Download Full-text

Morphological and Metabolic Alteration of Cerebellum in Patients with Post-Stroke Depression

Cellular Physiology and Biochemistry ◽

10.1159/000452557 ◽

2016 ◽

Vol 40 (3-4) ◽

pp. 420-430 ◽

Cited By ~ 7

Author(s):

Ling Zhang ◽

Rubo Sui ◽

Lei Zhang ◽

Zhuang Zhang

Keyword(s):

Magnetic Resonance ◽

Depression Scale ◽

Resonance Spectroscopy ◽

Hamilton Depression Scale ◽

Stroke Patients ◽

1H Mrs ◽

Post Stroke ◽

Cont Group ◽

Post Stroke Depression ◽

Norm Group

Background: To study morphological and metabolic changes of cerebellum with multimodality magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (1H-MRS), respective, to explore correlation between cerebellum alteration and severity of depression in patients with post-stroke depression. Methods: 60 subjects, including 40 stroke patients and 20 healthy volunteers were enrolled. Depression of stroke patients was tested by Self-rating Depression Scale (SDS) and Hamilton Depression Scale (HAMD), based on which stroke-patients were grouped into post-stroke depression (PSD group) and without post-stroke depression (CONT group). Results: Volume of cerebellum decreased in PSD group and CONT group compared with healthy volunteer (NORM) group. White matter of cerebellum in PSD group and CONT group was disrupted; such disruption was significantly in PSD group. In addition, there was correlation between cerebellum volume and FA and HDRS scores (P<00.01). The Cho/Cr and Cho/NAA ratios in cerebellum contralateral to stroke lesion in PSD were higher than those in NORM group (P<0.05). Cho/Cr and Cho/NAA ratios in contralateral cerebellum and ratio difference of Cho/Cr in bilateral cerebellum were positively correlated with HAMD scales (P<0.05). Conclusion: Morphologic and metabolic alterations are evident in patients with post-stroke depression, indicating possible involvement of cerebellum in post-stroke-depression occurrence.

Download Full-text

Abstract P32: Potential Underuse of Antidepressants in Post Stroke Depression: Data From the AVAIL Registry

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_1.ap32 ◽

2011 ◽

Vol 4 (suppl_1) ◽

Author(s):

Nada El Husseini ◽

Daniel T Laskowitz ◽

Amanda C Guidon ◽

DaiWai M Olson ◽

Xin Zhao ◽

...

Keyword(s):

Ischemic Stroke ◽

Cognitive Status ◽

Stroke Recurrence ◽

Stroke Patients ◽

Living Situation ◽

Factors Associated ◽

Post Stroke ◽

Depression Status ◽

Post Stroke Depression ◽

Antidepressant Use

Background: Post-stroke depression is common, yet little is known about factors associated with antidepressant use in this population Methods: Data from the multicenter, prospective Adherence eValuation After Ischemic stroke-Longitudinal (AVAIL) registry was used to identify patients with post-stroke depression and to describe factors associated with antidepressant use. The analysis was performed after 3 months in 1751 ischemic stroke patients who had been admitted to 97 hospitals nationwide; 12 month follow-up was available for 1637 patients. The Get with the Guidelines-Stroke database was used to collect baseline data. Patients were classified as depressed based on a self-report scale (the Patient Health Questionnaire-8; score range 0 to 24, score ≥10 indicating depression). Frequencies were compared with Pearson X 2 and unadjusted ORs were calculated. Results: The prevalence of post stroke depression was similar at 3 and 12 months (19% [331/1751] vs 17% [280/1637], respectively, p=0.17). Regardless of depression status, antidepressant use was higher at 12 months (16% [287/1751] vs 20% [334/1637], p=0.002). Antidepressant use was also higher at 12 months in depressed patients (25% [84/331] vs 35% [98/280], p=0.009). The odds of antidepressant use at 3 months was higher in women than men (OR 1.6, 95% CI 1.2-2.1), Whites vs. Blacks (OR 1.7, 95% CI 1.1-2.8), in patients with vs. without cognitive deficits (OR 1.6, 95% CI 1.2-2.1) and in those with more severe disabilities (mRS≥3 vs. mRS<3, OR 1.7, 95% CI 1.3-2.3). Use did not vary with educational level, marital status, living situation, medication insurance coverage, or stroke recurrence. Similar trends were present at 12 months, except with higher use in those with recurrent stroke or TIA (OR 2.1, 95% CI 1.4-3.1). Conclusion: Three-quarters of depressed stroke patients at 3-months and nearly two-thirds at 12 months were not receiving antidepressants. Regardless of depression status, utilization of antidepressants after 3 and 12 months varied based on gender, race/ethnicity, cognitive status, disability level, and after 12-months, stroke recurrence. The reasons for the apparent underuse of antidepressants in patients with prevalent post-stroke depression require further study.

Download Full-text

Neuropsychological rehabilitation of memory in post-stroke patients with brain nonspecific structure injury

SHS Web of Conferences ◽

10.1051/shsconf/202110103023 ◽

2021 ◽

Vol 101 ◽

pp. 03023

Author(s):

Tatiana Aleksandrovna Mardasova ◽

Pavel Rafaelevich Iusupov

Keyword(s):

Life Expectancy ◽

Management System ◽

Social Activity ◽

Stroke Patients ◽

Neuropsychological Rehabilitation ◽

Memory Impairments ◽

Post Stroke

The relevance of the study of the neuropsychological rehabilitation of memory impairments in stroke and the increasing role of the development of the rehabilitation direction to build a competent management system for such patients suggests good conditions for improving the health of the population, increasing the life expectancy and social activity of people.

Download Full-text

LACK OF EMPHASIS ON PSYCHOLOGICAL REHABILITATION FOR STROKE PATIENTS

Pakistan Journal of Rehabilitation ◽

10.36283/pjr.zu.1.1/009 ◽

2012 ◽

Vol 1 (1) ◽

pp. 2

Author(s):

Samina Masood Haider

Keyword(s):

Emotional Difficulties ◽

Stroke Survivors ◽

Stroke Patients ◽

Post Stroke ◽

Post Stroke Depression ◽

The Many ◽

Over Time

It has been observed that most of the patients are not aware of the dilapidating affects of post stroke depression on their recovery, survival and a return to normal activities of life. The lack of emphasis on psychological rehabilitation for stroke patients is a source of concern for me and I would like to bring to your attention about the facts regarding the implications of proper psychological rehabilitation is not undertaken. Stroke survivors report a range of emotional difficulties, most common being fear, anxiety, frustration, anger, sadness and a sense of grief for their physical and mental losses. Usually these feelings may fade over time however, some patients may struggle with adjusting to the many changes following stroke. When this happens these feelings can develop into depression. It is estimated that approximately one-third of stroke1 survivors develop post-stroke depression (PSD)

Download Full-text

Benefits of antidepressant treatment after a stroke

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.225 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S315-S315 ◽

Cited By ~ 2

Author(s):

O. Zerriaa ◽

O. Moula ◽

S. Ben Saadi ◽

I. Jelalia ◽

R. Ghachem

Keyword(s):

Functional Recovery ◽

Cognitive Skills ◽

Antidepressant Treatment ◽

Antidepressant Drugs ◽

Antidepressant Therapy ◽

Motor Deficit ◽

Stroke Patients ◽

Double Blind ◽

Post Stroke ◽

Post Stroke Depression

IntroductionStroke is an important cause of morbidity and is responsible for 9% of all deaths worldwide. The most frequent neuropsychiatric consequence of stroke is post-stroke depression (PSD). It has been shown to be associated with both impaired recovery and increased mortality. The aim of our study is to determine the benefits of antidepressant prescription after a stroke.MethodThe databases from Medline and PubMed were reviewed for articles related to post-stroke depression (PSD), antidepressant treatment and stroke, post-stroke depression and functional recovery, stroke related impairment.ResultsAntidepressant drugs have been shown to be effective in treating PSD in six double blind randomized studies. Patients treated with antidepressants had better recovery from disability than patients who did not receive antidepressant therapy: it was proved that antidepressant drugs cause an improvement in cognitive skills and functional recovery in PSD patients. In patients with ischemic stroke and moderate to severe motor deficit, the early prescription of fluoxetine with physiotherapy enhanced motor recovery after 3 months. Some studies showed that PSD can be effectively prevented: nortriptyline, fluoxetine, milnacipran and sertraline appeared to be efficacious in preventing depression after stroke and are to use without significant adverse effects in stroke patients.ConclusionAntidepressant treatment plays an increasing role in the management of patients with acute stroke. Therefore, early initiation of antidepressant therapy, in non-depressed stroke patients, may reduce the odds for development of PSD, and improve cognitive and functional recovery.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

Association among depression, cognitive impairment and executive dysfunction after stroke

Dementia & Neuropsychologia ◽

10.1590/s1980-57642012dn06030007 ◽

2012 ◽

Vol 6 (3) ◽

pp. 152-157 ◽

Cited By ~ 13

Author(s):

Luisa Terroni ◽

Matildes F.M. Sobreiro ◽

Adriana B. Conforto ◽

Carla C. Adda ◽

Valeri D. Guajardo ◽

...

Keyword(s):

Cognitive Impairment ◽

Neuropsychological Tests ◽

Executive Dysfunction ◽

Stroke Survivors ◽

Stroke Patients ◽

Adequate Treatment ◽

Post Stroke ◽

Quantitative Studies ◽

Post Stroke Depression ◽

The Relationship

ABSTRACT The relationship between depression and cognitive impairment, frequent after stroke, is complex and has not been sufficiently elucidated. Objective: To review the relationship between post-stroke depression and cognitive impairment. Methods: We performed a PubMed database search spanning the last ten years, using the terms post-stroke depression, cognitive dysfunction, cognitive impairment and neuropsychological tests. Our target studies were original quantitative studies that investigated the relationship between post-stroke depression (PSD) and cognitive impairment in stroke patients. Articles published in English, Spanish, Italian and Portuguese were considered. Selection criteria were the use of neuropsychological tests to assess cognitive function, and of either instruments to diagnose major depression, or scales to assess depressive symptoms, within the first three months after stroke. Results: Six original quantitative studies fulfilled the criteria. The prevalence of PSD within the first three months after stroke ranged from 22% to 31%. Incidence ranged from 25% to 27% and was evaluated in only two studies. PSD was associated with increased cognitive impairment. Cognitive impairment was reported in 35.2% to 87% of the patients. Post-stroke cognitive deficits were reported mostly in executive function, memory, language, and speed of processing. Conclusion: Executive dysfunction and depression occur in stroke survivors, are frequently coexistent, and also associated with worse stroke prognosis. Healthcare professionals need to address and provide adequate treatment for depression and executive dysfunctions in stroke patients early in the first three months after stroke. Future studies should evaluate the efficacy of programs evaluating the early detection and treatment of PSD and executive dysfunction in stroke survivors.

Download Full-text

The Role of Continuous Theta Burst TMS in the Neurorehabilitation of Subacute Stroke Patients: A Placebo-Controlled Study

Frontiers in Neurology ◽

10.3389/fneur.2021.749798 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ana Dionísio ◽

Rita Gouveia ◽

João Castelhano ◽

Isabel Catarina Duarte ◽

Gustavo C. Santo ◽

...

Keyword(s):

Motor Function ◽

Primary Motor Cortex ◽

Phase Iii ◽

Repeated Measure ◽

Controlled Study ◽

Stroke Patients ◽

Post Stroke ◽

Subacute Stroke ◽

Theta Burst

Objectives: Transcranial magnetic stimulation, in particular continuous theta burst (cTBS), has been proposed for stroke rehabilitation, based on the concept that inhibition of the healthy hemisphere helps promote the recovery of the lesioned one. We aimed to study its effects on cortical excitability, oscillatory patterns, and motor function, the main aim being to identify potentially beneficial neurophysiological effects.Materials and Methods: We applied randomized real or placebo stimulation over the unaffected primary motor cortex of 10 subacute (7 ± 3 days) post-stroke patients. Neurophysiological measurements were performed using electroencephalography and electromyography. Motor function was assessed with the Wolf Motor Function Test. We performed a repeated measure study with the recordings taken pre-, post-cTBS, and at 3 months' follow-up.Results: We investigated changes in motor rhythms during arm elevation and thumb opposition tasks and found significant changes in beta power of the affected thumb's opposition, specifically after real cTBS. Our results are consistent with an excitatory response (increase in event-related desynchronization) in the sensorimotor cortical areas of the affected hemisphere, after stimulation. Neither peak-to-peak amplitude of motor-evoked potentials nor motor performance were significantly altered.Conclusions: Consistently with the theoretical prediction, this contralateral inhibitory stimulation paradigm changes neurophysiology, leading to a significant excitatory impact on the cortical oscillatory patterns of the contralateral hemisphere. These proof-of-concept results provide evidence for the potential role of continuous TBS in the neurorehabilitation of post-stroke patients. We suggest that these changes in ERS/ERD patterns should be further explored in future phase IIb/phase III clinical trials, in larger samples of poststroke patients.

Download Full-text