Table 1.
Summary of Studies on the Non-Pharmacologic Interventions for PSD
| Author | Year | Study Design | N | Intervention | Comparator | Depression Outcome Measures | Outcome |
|---|---|---|---|---|---|---|---|
| Bueno et al | 2011 | Case report | 1 | Trancranial Direct Current Stimulation | Improvement in mood and cognitive impairment | ||
| Valiengo et al | 2016 | Case series | 4 | Trancranial Direct Current Stimulation | Stroke Aphasic Depression Score, Aphasic Depression Rating Scale | Improvement in mood among aphasic and depressed patients sustained for 4 weeks | |
| Valiengo et al | 2016 | RCT | 48 | Trancranial Direct Current Stimulation | Sham control | Hamilton Depression Scale | Active TDCS superior to sham in the improvement of PSD |
| Valiengo et al | 2013 | RCT | Phase II-25 Phase II-42 |
Trancranial Direct Current Stimulation | Sertraline | Montgomery-Asberg Depression Rating Scale | tDCS should be optimized in treatment resistant depression |
| Gu et al | 2017 | RCT | 24 | Transcranial Magnetic Stimulation | Sham control | Hamilton Depression Scale 17 Beck Depression Inventory |
rTMS decressed depression scores compared to sham |
| Frey et al | 2020 | Prospective Cohort | 6 | Transcranial Magnetic Stimulation | Hamilton Depression Scale | Accelerated rTMS protocol is a safe adjunct/alternative for PSD | |
| Hordacore et al | 2021 | RCT | 11 | Transcranial Magnetic Stimulation | Sham control | Beck Depression Index | Active rTMS improved depression and is well tolerated |
| Shao et al | 2021 | Meta-Analysis | 7 RCTs, 351 patients | Transcranial Magnetic Stimulation | Various | Hamilton Depression Scale, clinical remission of depression | rTMS could be an effective treatment for PSD and more effective in Asians |
| Lincoln et al | 1997 | RCT | 136 | Cognitive Behavioral Therapy (CBT) | Hamilton Depression Scale 17 Beck Depression Inventory |
CBT improved depression among PSD patients | |
| Lincoln et al | 2003 | RCT | 123 | Cognitive Behavioral Therapy (CBT) | Beck Depression Inventory Wakefield Depression Inventory |
CBT was ineffective in the treatment of PSD | |
| Ward et al | 2016 | 48 | Cognitive Behavioral Therapy (CBT) | Beck Depression Inventory Hospital Anxiety Depression Scale |
CBT was effective in the treatment of PSD | ||
| Olukalde et al | 2017 | 30 | Cognitive Behavioral Therapy (CBT) | Pschoeducation, Standard care | Beck Depression Index | CBT improved depression among PSD patients | |
| Simblette et al | 2017 | RCT | 134 | Computerized CBT (cCBT) | Computerized cognitive remediation therapy (cCRT) | Beck Depression Inventory-II (BDI-II) Beck Anxiety Inventory (BAI) |
Both cCBT and cCRT are equally useful for PSD |
| Kootker et al | 2017 | RCT | 61 | Augmented CBT | Computerized Cognitive Training (CCT) | Hospital Anxiety and Depression Scale | CBT intervention was not superior to CCT for PSD |
| Wang et al | 2018 | Meta-Analysis | 23 studies 1972 patients | Cognitive Behavioral Therapy (CBT) | Various | Various | CBT has positive effects on PSD |
| Lai et al | 2006 | RCT | 100 | Therapeutic exercise | Standard care | Geriatric Depression Scale Stroke Impact Scale Medical Outcomes Study 36-Item Short Form. |
Exercise may help improve PSD and the quality of life of patients post stroke |
| Smith et al | 2008 | RCT | 22 | Treadmill training | Weekly phone call | Beck Depression Index Stroke Impact Scale |
Task specific intervention to improve gait may secondarily improve PSD |
| Aguiar et al | 2020 | RCT | 20 | Treadmill training | Standard care | Patient Health Questionnaire | Aerobic threadmill improved PSD |
| Sims at el | 2009 | RCT | 22 | Community-based progressive resistance training (PRT) program | Wait-list comparison group | Centre for Epidemiologic Studies for Depression Scale Short Form-12 Health Survey Questionnaire (SF-12) Satisfaction with Life Scale (SWLS) |
Trend to benefit in the PRT group but not significant difference compared to controls |
| Eng et al | 2014 | Meta-Analysis | 13 RCT, N=1022 | Exercise training | Various | Various | Exercise may be a potential treatment to improve PSD in the subacute to chronic period |
| Aidar et al | 2018 | RCT | 36 | Aquatic Exercise Program | Not described | State-Trait Anxiety Inventory Beck Depression Inventory |
Aquatic training improved depression and anxiety in PSD |
| Dela Cruz et al | 2020 | RCT | 45 | Aquatic Therapy Program and land-based physiotherapy | Land-based physiotherapt | SF-36 quality of life scale Resilience scale |
Aquatic exercises have positive effects on mood and QOL |
| Chan et al | 2012 | RCT | 14 | Yoga and exercise | Exercise only | Geriatric Depression Scale (GDS15) State Trait Anxiety Inventory (STAI) |
No differences in depression and anxiety between intervention group and control |
| Immink et al | 2014 | RCT | 22 | Yoga | No treatment | Geriatric Depression Scale (GDS15) State Trait Anxiety Inventory (STAI) |
Yoga improved QOL and anxiety among PSD patients. |
| Piliae | 2014 | RCT | 145 | Tai-chi (Yang style) | Strength exercises and usual care | Short-Form Health Survey Center for Epidemiologic Studies Depression Scale |
Tai-chi improved physical function and QOL among post-stroke patients |
| Kim et al | 2015 | RCT | 22 | Ta-chi and general physiotherapy | General physiotherapy | SF-36 survey | Tai-chi improved QOL of of PSD patients |
| Lyu et al | 2021 | RCT | 11 RCTs, N=723 | Tai-chi | Conventional rehabilitation | Various depression scores | Tai-chi improved depression in stroke survivors |
| Zhang et al | 2005 | RCT | 45 | Brain resuscitation acupuncture | Fluoxetine | Hamilton Depression Rating Scale | Brain resuscitation acupuncture improves depression in patients with PSD with quick effects |
| Liu et al | 2006 | RCT | 560 | Acupuncture-moxibustion | Fluoxetine | Hamilton Depression Scale | Acupuncture-moxibustion resulted in significant improvement of depression with similar therapeutic effect as medical treatment |
| He et al | 2007 | Cross-sectional study | 256 | Acupuncture | Amitriptyline | Self-Rating Depression Scale (SDS) and Hamilton Rating Scale for Depression (HRSD) | Acupuncture significantly improves depression and is superior to medical treatment |
| Guo et al | 2009 | Cross-sectional study | 120 | Linggui Bafa acupuncture | Sertraline and no treatment | Hamilton Depression Scale, SF36, Function Independent Measure (FIM) | Acupuncture significantly improves depression and QOL and is superior to medical treatment |
| Wu et al | 2010 | Cross-sectional study | 300 | Acupuncture | Fluoxetine | Hamilton Depression Scale | Acupuncture is effective in improving PSD |
| Nie et al | 2011 | 63 | Acupuncture and Moxibustion | Fluoxetine | Hamilton Depression Scale | Acupuncture is effective in improving PSD | |
| Youn et al | 2013 | Cross-sectional study | 28 | Electro-acupuncture | Hamilton Depression Scale, Beck Depression Index | Electro-acupuncture can improve PSD | |
| Li et al | 2016 | Meta-Analysis | 813 | Electro-acupuncture | Anti-depressants | Hamilton Depression Scale | No difference in electroacupuncture and medical treatmenr |
| Sun et al | 2015 | RCT | 93 | Acupuncture and Fluoxetine | Acupuncture or Fluoxetine | Hamilton Depression Scale | Acupuncture and Fluoxetine are superior to either Fluoxtine or acupuncture alone |
| Sun et al | 2015 | RCT | 63 | Acupuncture (Governor vessel) and Fluoxetine | Fluoxetine | Hamilton Depression Scale | Acupuncture and Fluoxetine is effective in PSD after 4 weeks of treatment |
| You et al | 2020 | RCT | 99 | Acupuncture (wrist ankle) and Fluoxetine | Sham needle + Fluoxetine | Hamilton Depression Scale, Self-rating Depression scale | Acupuncture (wrist ankle) and Fluoxetine can relieve PSD |
| Man et al | 2014 | RCT | 43 | Dense cranial electro-acupuncture stimulation (DCEAS) and body acupuncture and SSRI | Non-invasive cranial electro-acupuncture and body acupuncture and SSRI | Hamilton Depression Scale Clinical Global Impression - Severity scale (CGI-S) | Dense cranial electro-acupuncture stimulation (DCEAS) is effective in reducing depressive symptoms among stroke patients |
| Zhang et al | 2017 | Meta-Analysis | 13 RCT 904 patients | Acupuncture and anti-depressants | Anti-depressants | Change in Hamilton Depression Scale | Combined acupuncture and antidepressant is more favorable than antidepressant alone in PSD |
| Zhang et al | 2019 | Meta-Analysis | 7 studies | Acupuncture | Anti-depressants | Change in Hamilton Depression Scale | Acupuncture is better than drug therapy in PSD |
| Sondergaard et al | 2006 | RCT | 63 | Light therapy and Citalopram | Various intensitiies of light therapy | Hamilton Depression Scale | High intensity light treatment is effective in the treatment of PSD |
| West et al | 2017 | RCT | 90 | Circadian light | Standard light | Hamilton Depression Scale, Major Depression Inventory scale (MDI) | Circadian light is effective in the long term in the management of PSD |
| Wang et al | 2020 | RCT | 46 | Sunlight | Standard care | Taiwanese Depression Scale | Light therapy improves PSD |
| Xiao et al | 2021 | RCT | 106 | Bright light therapy and Escitalopram | Escitalopram | Hamilton Depression Scale | Bright light therapy and Escitalopram are effective in improvement in PSD |
| Sarkamo et al | 2008 | RCT | 60 | Self-selected music or audio books | Standard care | Profile of Mood States | Music listening during the early post-stroke stage can enhance cognitive recovery and prevent negative mood. |
| Jun et al | 2013 | Quasi experimental design | 30 | Music movement therapy | Standard care | Center for Epidemiologic Studies Depression Scale (CES-D) | Music therapy improved mood in the first 2 weeks of stroke improved patients’ mood |
| Van Vugt | 2014 | 28 | Music therapy played in synchrony | Music therapy played individually | Profile of Mood States (POMS). | Music therapy improved mood regardless of whether performed individually or in synchrony | |
| Kim et al | 2011 | RCT | 18 | Music therapy | Standard care | Beck Depression Inventory | Music therapy improved depression of PSD patients |
| Sumakul | 2020 | 59 | Music therapy | Standard care | Hamilton Depression Scale | Music therapy improved depression of PSD patients | |
| Baylan et al | 2020 | RCT | 72 | Mindful music listening | Standard music listening or audiobook listening | Hospital Anxiety and Depression Scale | Mindful music therapy did not significantly improve mood among PSD patients |
| Lin et al | 2017 | 92 | Five phases in Traditional Chinese Medicine | Sertraline and/or acupuncture | Hamilton Depression Scale | Music therapy plus acupuncture improved PSD | |
| Kongkasuwan | 2016 | RCT | 118 | Creative Art therapy | Conventional Physical therapy | Hospital Anxiety and Depression Scale | Creative art therapy combined with conventional physical therapy can significantly decrease depression |
| Kim et al | 2013 | 28 | Color therapy | Standard care | Purpose in life questionnaire | Color therapy improved the purpose in life among stroke patients | |
| Ali et al | 2014 | 6 | Art therapy | Hospital Anxiety and Depression Scale | No difference in depression scores before and after treatment | ||
| Minshall et al | 2020 | RCT | 173 | Personalized psychosocial intervention | Standard care | Hospital Anxiety and Depression Scale | Personalized psychosocial intervention did not impact PSD at 6 months |
| Watkins et al | 2007 | RCT | 207 | Motivational interviewing | Standard care | General Health Questionnaire | Motivational interviewing leads to an improvement in patients’ mood 3 months after stroke. |
| Mitchell et al | 2009 | RCT | 101 | Brief behavioral intervention and antidepressant | Standard care | Hamilton Depression Scale | A brief psychosocial-behavioral intervention is highly effective in reducing depression in both the short and long term. |
| Watkins et al | 2011 | RCT | 411 | Motivational interviewing | Standard care | General Health Questionnaire | Motivational interviewing improves patients’ mood and reduces mortality 12 months poststroke. |
| Chalmers et al | 2019 | Prospective Cohort | 28 | Problem solving | Wait-list comparison group | Center for Epidemiologic Studies Depression Scale (CES-D) | Younger stroke survivors may benefit from age appropriate psychological support |
| Hadidi et al | 2014 | RCT (feasibility) | 22 | Problem solving | Standard care | Center for Epidemiologic Studies Depression Scale (CES-D) | Problem solving therapy may be feasible for PSD |
| Fang et al et al | 2017 | Pilot trial | 42 | Constructive integrative psychosocial intervention (CIPI) | Standard care | Hospital Anxiety and Depression Scale | CIPI appears to be of incremental value in treating depression as well as anxiety in subacute care |
| Ostwald et al | 2014 | RCT | 159 | Psychoeducational program (home-based) in dyads | Mailed program | Geriatric Depression Scale | Intervention done in dyads are effective in PSD |
| Smith et al et al | 2016 | Mixed-methods pilot study | 20 | Psychoeducational program (home-based) in dyads | Standard care | Center for Epidemiologic Studies Depression Scale (CES-D) | Nurse-initiated cognitive coping intervention was supported by experimental group’s elements. |
| Minshall et al | 2019 | Meta-Analysis | 31 RCTs 5715 patients | Psychosocial interventions | Standard care | Various measures of depression | Psychosocial interventions reduced depressive symptoms in stroke survivors and their carers. |