Abstract:

Objective To assess the effectiveness of cognitive behavioral therapy with antidepressants on poststroke depression. Methods All published research about randomized controlled trials (RCTs) focusing on cognitive behavioral therapy with antidepressants on post-stroke depression on PubMed, Cochrane library, CNKI, VIP, Wanfang Standards Database were searched. Meta-analysis was conducted by RevMan 5.3 software based on data which was eligible for inclusion criteria. The improvement condition of Hamilton Depression Scale (HAMD) and rehabilitation status of neuro-function by Fugl-Meyer Motor-Function Scale were analyzed to compare the effectiveness of two therapies. Results A total of 9 RCTs were included, involving 584 post-stroke depression patients. The results of meta-analysis of the subgroup of early phase (4 weeks, 8 weeks) and long-term phase (12 weeks, 21 weeks, 52 weeks) revealed that cognitive behavioral therapy with antidepressants was more effective in decreasing depression score than control group (4 weeks WMD -1.42, 95% confidence interval [CI ] [-2.02,-0.78], P <0.001; 8 weeks WMD -3.74, 95%CI [-5.50,-1.99], P <0.001; 12 weeks WMD -1.86,95%CI [-2.55,-1.17], P <0.001; 21 weeks WMD -2.20, 95%CI [-3.09,-1.30], P <0.001; 52 weeks WMD -3.73, 95%CI [-4.75,-2.70], P <0.001), and the results also showed that cognitive behavioral therapy with antidepressants was more effective in motor function rehabilitation than control group (WMD -0.32, 95%CI [-0.60, -0.04], P =0.03). Conclusion Cognitive behavioral therapy with antidepressants on post-stroke depression is more effective in decreasing depression score, and promotes the motor functional recovery of patients.

Key words: Post-stroke depression; Cognitive behavioral therapy; Antidepressants; Systematic review

摘要：

目的 系统评价认知疗法联合抗抑郁药物对卒中后抑郁（post-stroke depression，PSD）患者的疗效。 方法 计算机检索Pub Med 、Cochr ane图书馆、中国知网、中国生物医学文献数据库、中文科技期刊数 据库、万方数据库中所有关于认知疗法联合抗抑郁药物治疗PSD患者的随机对照试验（randomized controlled trial，RCT）。对符合纳入标准的文献用ReVMan 5.3软件对数据进行Meta分析，分析两组治疗 方法对汉密尔顿抑郁量表（Hamilton Depression Scale，HAMD）评分的改善情况，以及神经功能恢复情况 （Fugl-Meyer运动评分量表）。 结果 共纳入9个RCTs，共计584例患者，对认知行为联合抗抑郁药物治疗PSD的早期（4周、8周）及 长期（12周、21周、52周）疗效做亚组分析，结果显示，与对照组相比，认知行为合并抗抑郁药物治 疗组更能显著降低患者早期及长期的HAMD评分[4周WMD -1.42，95%可信区间（confidence interval， CI）（-2.02，-0.78），P＜0.001；8周WMD -3.74，95%CI（-5.50，-1.99），P＜0.001；12周WMD -1.86， 95%CI（-2.55，-1.17），P＜0.001；21周WMD -2.20，95%CI（-3.09，-1.30），P＜0.001；52周WMD -3.73，95%CI（-4.75，-2.70），P＜0.001]，同时也促进了治疗8周后患者Fugl -Meyer运动评分量表的改 善[WMD -0.32，95%CI（-0.60，-0.04），P =0.03]。 结论 认知行为联合抗抑郁药物较单纯使用抗抑郁药物更能显著降低PSD患者的抑郁评分，促进 患者运动功能的康复。

关键词: 卒中后抑郁; 认知行为疗法; 抗抑郁药物; 系统评价