Non‐invasive brain stimulation for treating post‐stroke depression: A network meta‐analysis.

Autor:	Yanyu, Sun, Ying, Li, Kexin, Li, Jin, Wu
Předmět:	BRAIN physiology STROKE treatment ANTIDEPRESSANTS MEDICAL databases PSYCHOLOGY information storage & retrieval systems STROKE META-analysis CONFIDENCE intervals SYSTEMATIC reviews STEREOTAXIC techniques COMPARATIVE studies MENTAL depression TRANSCRANIAL direct current stimulation DECISION making in clinical medicine PROBABILITY theory DISEASE complications
Zdroj:	International Journal of Geriatric Psychiatry; Jun2023, Vol. 38 Issue 6, p1-13, 13p
Abstrakt:	Objective: To compare the antidepressant effects and tolerability of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) treatments in patients with post‐stroke depression (PSD). Methods: We included randomized controlled trials comparing active stimulation with sham stimulation. Primary outcomes were the depression score after treatment, presented as standardized mean differences with 95% confidence intervals. Response/remission and long‐term antidepressant efficacy were also examined. We estimated effect‐size using pairwise and Bayesian network meta‐analysis (NMA) with random‐effects model. Results: We identified 33 studies (total n = 1793). In NMA, 5 of 6 treatment strategies were associated with higher effect compared with sham therapy: dual rTMS (standardized mean differences = −1.5; 95% confidence interval = −2.5 to −0.57), dual LFrTMS (−1.5, −2.4 to −0.61), dual tDCS (−1.1, −1.5 to −0.62), HFrTMS (−1.1, −1.3 to −0.85) and LFrTMS (−0.90, −1.2 to −0.6). And dual rTMS, dual LFrTMS or HFrTMS may be more effective than other interventions for achieving antidepressant effects. Regarding secondary outcomes, rTMS can promote depression remission and response, and alleviate depression for at least 1 month. rTMS and tDCS were well tolerated. Conclusions: Bilateral rTMS and HFrTMS are considered top‐priority non‐invasive brain stimulation (NIBS) interventions for improving PSD. Dual tDCS and LFrTMS are also efficient. Significance: The findings of this study provide evidence for considering NIBS techniques as alternative or add‐on treatments for patients with PSD. This work also emphasizes the need for future clinical trials to address the inadequacies identified in this review to optimize methodological quality. Key points: Bilateral repetitive transcranial magnetic stimulation (rTMS) and high‐frequency rTMS are considered top‐priority non‐invasive brain stimulation interventions for improving post‐stroke depression.Dual transcranial direct current stimulation and low‐frequency rTMS are also efficient.Clinical trials must optimize methodological quality by addressing the inadequacies identified in this review. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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