Cochrane · systematic review · CD003437
Pharmacological, non‐invasive brain stimulation and psychological interventions, and their combination, for treating depression after stroke
Allida, SM, Hsieh, C-F, Cox, KL, et al. · Cochrane Database of Systematic Reviews · 2023 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
34
current version
GRADE rated
22
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 12 · 35.3%Very low 19 · 55.9%Low 3 · 8.8%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyPharmacological interventions compared to placebo for treating depression after stroke
Population: people with depression after stroke
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Depression: meeting study criteria for depression at end of treatment (primary outcome) Pharmacological interventions vs placebo | RR 0.7 [0.55, 0.88] | 8 studies · 1025 participants | Very low Downgraded: risk of bias |
Depression: < 50% reduction in scale scores at end of treatment (primary outcome) Pharmacological interventions vs placebo | RR 0.48 [0.32, 0.7] | 6 studies · 511 participants | Very low Downgraded: risk of bias |
Depression: mean scores at end of treatment (secondary outcome) Pharmacological interventions vs placebo | no estimate extracted | 15 studies · 1535 participants | Ungraded |
Depression: meeting study criteria for depression at end of Pharmacological interventions vs placebo | no estimate extracted | 0 studies · 0 participants | Ungraded |
Adverse events: death (secondary outcome) Pharmacological interventions vs placebo | RR 0.64 [0.2, 2.07] | 9 studies · 848 participants | Very low Downgraded: risk of bias |
Adverse events: all ‐ central nervous system events (e.g. confusion, sedation, tremor) (secondary outcome) Pharmacological interventions vs placebo | RR 1.55 [1.12, 2.15] | 5 studies · 488 participants | Very low Downgraded: risk of bias |
Adverse events: all ‐ gastrointestinal effects (e.g. constipation, diarrhoea) (secondary outcome) Pharmacological interventions vs placebo | RR 1.62 [1.19, 2.19] | 4 studies · 473 participants | Very low Downgraded: risk of bias |
Non‐invasive brain stimulation compared to sham non‐invasive brain stimulation and/or usual care for treating depression after stroke
Population: people with depression after stroke
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Depression: meeting study criteria for depression at end of treatment (primary outcome) Non‐invasive brain stimulation vs sham non‐invasive brain stimulation and/or usual care | RR 0.67 [0.39, 1.14] | 2 studies · 130 participants | Very low Downgraded: risk of bias |
Depression: < 50% reduction in scale scores at end of treatment (primary outcome) Non‐invasive brain stimulation vs sham non‐invasive brain stimulation and/or usual care | RR 0.84 [0.52, 1.37] | 2 studies · 130 participants | Very low Downgraded: risk of bias |
Depression: mean scores at end of treatment (secondary outcome) Non‐invasive brain stimulation vs sham non‐invasive brain stimulation and/or usual care | no estimate extracted | 8 studies · 505 participants | Very low Downgraded: risk of bias |
Depression: meeting study criteria for depression at end of Non‐invasive brain stimulation vs sham non‐invasive brain stimulation and/or usual care | no estimate extracted | 0 studies · 0 participants | Ungraded |
Adverse events: death ‐ at end of treatment (secondary outcome) Non‐invasive brain stimulation vs sham non‐invasive brain stimulation and/or usual care | no estimate extracted | 4 studies · 393 participants | Ungraded |
Adverse events: all ‐ central nervous system events (e.g. confusion, headache, tremor) (secondary outcome) Non‐invasive brain stimulation vs sham non‐invasive brain stimulation and/or usual care | RR 0.61 [0.23, 1.64] | 4 studies · 183 participants | Low Downgraded: risk of bias, inconsistency |
Adverse events: all ‐ other events ‐ not listed above (e.g. dysuria, neck pain, eye discomfort) (secondary outcome) Non‐invasive brain stimulation vs sham non‐invasive brain stimulation and/or usual care | RR 0.47 [0.16, 1.39] | 4 studies · 183 participants | Low Downgraded: risk of bias, inconsistency |
Psychological therapy compared to usual care and/or attention control for treating depression after stroke
Population: people with depression after stroke
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Depression: meeting study criteria for depression at end of treatment (primary outcome) Psychological therapy vs usual care and/or attention control | RR 0.77 [0.62, 0.95] | 6 studies · 521 participants | Very low Downgraded: risk of bias |
Depression: < 50% reduction in scale scores at end of treatment (primary outcome) Psychological therapy vs usual care and/or attention control | no estimate extracted | 0 studies · 0 participants | Ungraded |
Depression: mean scores at end of treatment (other outcome) Psychological therapy vs usual care and/or attention control | no estimate extracted | 17 studies · 1568 participants | Ungraded |
Depression: meeting study criteria for depression at end of Psychological therapy vs usual care and/or attention control | RR 0.85 [0.59, 1.21] | 3 studies · 201 participants | Very low Downgraded: risk of bias |
Adverse events: death ‐ at end of treatment (secondary outcome) Psychological therapy vs usual care and/or attention control | RR 0.65 [0.26, 1.66] | 9 studies · 889 participants | Very low Downgraded: risk of bias |
Adverse events: all ‐ central nervous system events (e.g. suicidal intentions) (secondary outcome) Psychological therapy vs usual care and/or attention control | RR 0.87 [0.2, 3.9] | 2 studies · 126 participants | Very low Downgraded: risk of bias |
Adverse events: all ‐ other events ‐ not listed above (e.g. fall, too ill) (secondary outcome) Psychological therapy vs usual care and/or attention control | RR 0.62 [0.13, 3.09] | 3 studies · 254 participants | Very low Downgraded: risk of bias |
Pharmacological intervention and psychological therapy (combination) compared to a pharmacological intervention and usual care or attention control (single) for treating depression after stroke
Population: people with depression after stroke
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Depression: meeting study criteria for depression at end of treatment (primary outcome) Pharmacological intervention and psychological therapy (combination) vs a pharmacological intervention and usual care or attention control (single) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Depression: < 50% reduction in scale scores at end of treatment (primary outcome) Pharmacological intervention and psychological therapy (combination) vs a pharmacological intervention and usual care or attention control (single) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Depression: mean scores at end of treatment (secondary outcome) Pharmacological intervention and psychological therapy (combination) vs a pharmacological intervention and usual care or attention control (single) | no estimate extracted | 3 studies · 278 participants | Very low Downgraded: risk of bias |
Depression: meeting study criteria for depression at end of Pharmacological intervention and psychological therapy (combination) vs a pharmacological intervention and usual care or attention control (single) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Adverse events: death ‐ at end of treatment (secondary outcome) Pharmacological intervention and psychological therapy (combination) vs a pharmacological intervention and usual care or attention control (single) | no estimate extracted | 1 study · 54 participants | Ungraded |
Adverse events: all ‐ gastrointestinal effects (e.g. constipation, diarrhoea) (secondary outcome) Pharmacological intervention and psychological therapy (combination) vs a pharmacological intervention and usual care or attention control (single) | no estimate extracted | 1 study · 54 participants | Ungraded |
Pharmacological intervention and non‐invasive brain stimulation (combination) compared to a pharmacological intervention and sham stimulation or usual care (single) for treating depression after stroke
Population: people with depression after stroke
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Depression: meeting the criteria for depression at end of treatment (primary outcome) Pharmacological intervention and non‐invasive brain stimulation (combination) vs a pharmacological intervention and sham stimulation or usual care (single) | RR 0.77 [0.64, 0.91] | 3 studies · 392 participants | Low Downgraded: risk of bias |
Depression: < 50% reduction in scale scores at end of treatment (primary outcome) Pharmacological intervention and non‐invasive brain stimulation (combination) vs a pharmacological intervention and sham stimulation or usual care (single) | RR 0.95 [0.69, 1.3] | 3 studies · 392 participants | Very low Downgraded: risk of bias |
Depression: mean scores at end of treatment (secondary outcome) Pharmacological intervention and non‐invasive brain stimulation (combination) vs a pharmacological intervention and sham stimulation or usual care (single) | no estimate extracted | 12 studies · 1055 participants | Very low Downgraded: risk of bias |
Depression: meeting study criteria for depression at end of Pharmacological intervention and non‐invasive brain stimulation (combination) vs a pharmacological intervention and sham stimulation or usual care (single) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Adverse events: death (secondary outcome) Pharmacological intervention and non‐invasive brain stimulation (combination) vs a pharmacological intervention and sham stimulation or usual care (single) | RR 1.06 [0.27, 4.16] | 5 studies · 487 participants | Very low Downgraded: risk of bias |
Adverse events: all ‐ central nervous system events (e.g. headache, seizures) (secondary outcome) Pharmacological intervention and non‐invasive brain stimulation (combination) vs a pharmacological intervention and sham stimulation or usual care (single) | RR 0.5 [0.05, 5.28] | 3 studies · 342 participants | Very low Downgraded: risk of bias |
Adverse events: all ‐ other events ‐ not listed above (e.g. insomnia, discomfort, headaches) (secondary outcome) Pharmacological intervention and non‐invasive brain stimulation (combination) vs a pharmacological intervention and sham stimulation or usual care (single) | RR 7 [0.38, 129.93] | 2 studies · 120 participants | Very low Downgraded: risk of bias |
Pharmacological intervention compared to placebo for treating depression after stroke
Population: people with depression after stroke
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Depression: meeting study criteria for depression at end of treatment (Analysis 1.1) Pharmacological intervention vs placebo | RR 0.7 [0.55, 0.88] | 8 studies · 1025 participants | Very low Downgraded: risk of bias |
Depression: < 50% reduction in scale scores at end of treatment (Analysis 1.2) Pharmacological intervention vs placebo | RR 0.47 [0.32, 0.69] | 6 studies · 511 participants | Very low Downgraded: risk of bias |
Depression: mean scores at end of treatment (Analysis 1.4) Pharmacological intervention vs placebo | no estimate extracted | NR | No studies |
Neurological function: mean scores at end of treatment (Analysis 1.13) Pharmacological intervention vs placebo | no estimate extracted | 4 studies · 304 participants | Very low Downgraded: risk of bias |
Adverse events: death ‐ at end of treatment (Analysis 1.14) Pharmacological intervention vs placebo | RR 0.64 [0.2, 2.07] | 9 studies · 848 participants | Very low Downgraded: risk of bias |
Adverse events: all ‐ central nervous system events (e.g. confusion, sedation, tremor) (Analysis 1.15) Pharmacological intervention vs placebo | RR 1.55 [1.12, 2.15] | 5 studies · 488 participants | Very low Downgraded: risk of bias |
Adverse events: all ‐ gastrointestinal effects (e.g. constipation, diarrhoea) (Analysis 1.15) Pharmacological intervention vs placebo | RR 1.62 [1.19, 2.19] | 4 studies · 473 participants | Very low Downgraded: risk of bias |
Non‐invasive brain stimulation compared to sham non‐invasive brain stimulation and/or usual care for treating depression after stroke
Population: people with depression after stroke
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Depression: meeting study criteria for depression at end of treatment (Analysis 2.1) Non‐invasive brain stimulation vs sham non‐invasive brain stimulation and/or usual care | no estimate extracted | NR | No studies |
Depression: < 50% reduction in scale scores at end of treatment (Analysis 2.2) Non‐invasive brain stimulation vs sham non‐invasive brain stimulation and/or usual care | no estimate extracted | NR | No studies |
Depression: mean scores at end of treatment (Analysis 2.3) Non‐invasive brain stimulation vs sham non‐invasive brain stimulation and/or usual care | no estimate extracted | 8 studies · 495 participants | Very low Downgraded: risk of bias |
Depression: mean scores at end of Non‐invasive brain stimulation vs sham non‐invasive brain stimulation and/or usual care | no estimate extracted | 3 studies · 170 participants | Very low Downgraded: risk of bias |
Neurological function: mean scores at end of treatment (Analysis 2.7) Non‐invasive brain stimulation vs sham non‐invasive brain stimulation and/or usual care | no estimate extracted | 3 studies · 290 participants | Very low Downgraded: risk of bias |
Adverse events: death ‐ at end of treatment (Analysis 2.8) Non‐invasive brain stimulation vs sham non‐invasive brain stimulation and/or usual care | no estimate extracted | NR | No studies |
Adverse events: all ‐ central nervous system events (e.g. confusion, sedation, tremor) (Analysis 2.9) Non‐invasive brain stimulation vs sham non‐invasive brain stimulation and/or usual care | no estimate extracted | NR | No studies |
Psychological therapy compared to usual care and/or attention control for treating depression after stroke
Population: people with depression after stroke
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Depression: meeting study criteria for depression at end of treatment (Analysis 3.1) Psychological therapy vs usual care and/or attention control | RR 0.77 [0.62, 0.95] | 6 studies · 521 participants | Very low Downgraded: risk of bias |
Depression: < 50% reduction in scale scores at end of treatment (Analysis 3.2) Psychological therapy vs usual care and/or attention control | no estimate extracted | NR | No studies |
Depression: average change in scores between baseline and end of treatment (Analysis 3.3) Psychological therapy vs usual care and/or attention control | no estimate extracted | 3 studies · 189 participants | Very low Downgraded: risk of bias |
Depression: mean scores at end of treatment (Analysis 3.4) Psychological therapy vs usual care and/or attention control | no estimate extracted | NR | No studies |
Depression: meeting study criteria for depression at end of Psychological therapy vs usual care and/or attention control | RR 0.85 [0.59, 1.21] | 3 studies · 201 participants | Very low Downgraded: risk of bias |
Adverse events: death ‐ at end of treatment (Analysis 3.17) Psychological therapy vs usual care and/or attention control | RR 0.65 [0.26, 1.66] | 8 studies · 831 participants | Very low Downgraded: risk of bias |
Adverse events: leaving the study early (including death) ‐ all dropouts and withdrawals (Analysis 3.19) Psychological therapy vs usual care and/or attention control | RR 0.83 [0.42, 1.63] | 8 studies · 784 participants | Very low Downgraded: risk of bias |
Pharmacological intervention and a form of psychotherapy (combination) compared to pharmacological intervention and usual care or attention control (single) for treating depression after stroke
Population: people with depression after stroke
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Depression: meeting study criteria for depression at end of treatment (Analysis 4.1) Pharmacological intervention and a form of psychotherapy (combination) vs pharmacological intervention and usual care or attention control (single) | no estimate extracted | NR | No studies |
Depression: < 50% reduction in scale scores at end of treatment (Analysis 4.2) Pharmacological intervention and a form of psychotherapy (combination) vs pharmacological intervention and usual care or attention control (single) | no estimate extracted | NR | No studies |
Depression: mean scores at end of treatment (Analysis 4.3) Pharmacological intervention and a form of psychotherapy (combination) vs pharmacological intervention and usual care or attention control (single) | no estimate extracted | 2 studies · 198 participants | Very low Downgraded: risk of bias |
Activities of daily living: mean scores at end of treatment (Analysis 4.5) Pharmacological intervention and a form of psychotherapy (combination) vs pharmacological intervention and usual care or attention control (single) | no estimate extracted | 2 studies · 198 participants | Very low Downgraded: risk of bias |
Neurological function: mean scores at end of treatment (Analysis 4.6) Pharmacological intervention and a form of psychotherapy (combination) vs pharmacological intervention and usual care or attention control (single) | no estimate extracted | NR | No studies |
Adverse events: death ‐ at end of treatment (Analysis 4.7) Pharmacological intervention and a form of psychotherapy (combination) vs pharmacological intervention and usual care or attention control (single) | no estimate extracted | NR | No studies |
Adverse events: all ‐ gastrointestinal effects (e.g. constipation, diarrhoea) (Analysis 4.8) Pharmacological intervention and a form of psychotherapy (combination) vs pharmacological intervention and usual care or attention control (single) | no estimate extracted | NR | No studies |
Non‐invasive brain stimulation and pharmacological intervention (combination) compared to pharmacological intervention and sham stimulation or usual care (single) for treating depression after stroke
Population: people with depression after stroke
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Depression: meeting study criteria for depression at end of treatment (Analysis 5.1) Non‐invasive brain stimulation and pharmacological intervention (combination) vs pharmacological intervention and sham stimulation or usual care (single) | no estimate extracted | NR | No studies |
Depression: < 50% reduction in scale scores at end of treatment (Analysis 5.2) Non‐invasive brain stimulation and pharmacological intervention (combination) vs pharmacological intervention and sham stimulation or usual care (single) | no estimate extracted | NR | No studies |
Depression: mean scores at end of treatment (Analysis 5.3) Non‐invasive brain stimulation and pharmacological intervention (combination) vs pharmacological intervention and sham stimulation or usual care (single) | no estimate extracted | 9 studies · 665 participants | Very low |
Activities of daily living: mean scores at end of treatment (Analysis 5.6) Non‐invasive brain stimulation and pharmacological intervention (combination) vs pharmacological intervention and sham stimulation or usual care (single) | no estimate extracted | 5 studies · 403 participants | Very low |
Neurological function: mean scores at end of treatment (Analysis 5.8) Non‐invasive brain stimulation and pharmacological intervention (combination) vs pharmacological intervention and sham stimulation or usual care (single) | no estimate extracted | 4 studies · 280 participants | Very low |
Adverse events: death ‐ at end of treatment (Analysis 5.9) Non‐invasive brain stimulation and pharmacological intervention (combination) vs pharmacological intervention and sham stimulation or usual care (single) | no estimate extracted | NR | No studies |
Adverse events: leaving the study early (including death) (Analysis 5.11) Non‐invasive brain stimulation and pharmacological intervention (combination) vs pharmacological intervention and sham stimulation or usual care (single) | RR 1.33 [0.32, 5.58] | 4 studies · 300 participants | Very low |