- 1Department
of Neurology and Clinical Research Center of Neurological Disease, The
Second Affiliated Hospital of Soochow University, Suzhou, China - 2Department of Neurology, Wuxi No.2 People’s Hospital, Jiangnan University Medical Center, Wuxi, China
Background: Post-stroke depression (PSD) is a
frequent complication following a stroke, characterized by prolonged
feelings of sadness and loss of interest, which can significantly impede
stroke rehabilitation, increase disability, and raise mortality rates.
Traditional antidepressants often have significant side effects and poor
patient adherence, necessitating the exploration of more suitable
treatments for PSD. Previous researchers and our research team have
discovered that Botulinum Toxin A (BoNT-A) exhibits antidepressant
effects. Therefore, our objective was to assess the efficacy and side
effects of BoNT-A treatment in patients with PSD.
Methods: A total of 71 stroke patients meeting
the inclusion criteria were allocated to the two group. 2 cases were
excluded due to severe neurological dysfunction that prevented
cooperation and 4 cases were lost follow-up. Ultimately, number of
participants in the BoNT-A group (n = 32) and Sertraline group (n = 33). Treatment efficacy was evaluated 1, 2, 4, 8 and 12 weeks post-treatment.
Results: There were no significant differences in baseline characteristics between the two groups (p > 0.05).
Both groups exhibited comparable treatment efficacy, with fewer side
effects observed in the BoNT-A group compared to the Sertraline group.
BoNT-A therapy demonstrated significant effects as early as the first
week (p < 0.05), and by the 12th week, there was a notable
decrease in neuropsychological scores, significantly lower than the
baseline level. The analysis revealed significant differences in
measurements of the Hamilton Depression Scale (HAMD) (F(770) = 12.547, p = 0.000), Hamilton Anxiety Scale (HAMA) (F(951) = 10.422, p = 0.000), Self-Rating Depression Scale (SDS) (F(1385) = 10.607, p = 0.000), and Self-Rating Anxiety Scale (SAS) (F(1482) = 11.491, p = 0.000).
Conclusion: BoNT-A treatment effectively reduces depression symptoms in patients with PSD on a continuous basis.
Introduction
Stroke is a cerebrovascular event resulting from a
sudden interruption of blood supply to the brain, causing irreversible
tissue damage. This condition encompasses thrombotic, embolic, or
hemorrhagic events. A common complication of stroke is post-stroke
depression (PSD), a mood disorder characterized by persistent emotional
depression and loss of interest (1).
Psychiatrists have observed PSD for nearly a century, and since the
1970s, numerous studies have been conducted to investigate this
condition. PSD is a prevalent and manageable complication of stroke (2), with meta-analyses estimating its prevalence to range from 18 to 33% (3, 4).
Werheid discovered an intriguing pattern where depressive symptoms in
stroke patients tend to worsen in the first 6 months, improve within a
year, and then worsen again after the second year (5).
PSD can increase disability and mortality rates, reduce rehabilitation
efficiency, and lead to a decline in motor function and quality of life,
placing a burden on both families and society (6).
The clinical manifestations of PSD can be classified into core and
non-core symptoms. Core symptoms consist of low mood, anhedonia, and
fatigue, while non-core symptoms include cognitive impairment, sleep
disturbances, unexplained pain, sexual dysfunction, appetite changes,
and gastrointestinal issues. However, due to the diverse and
non-specific nature of these symptoms, diagnosis and treatment of PSD
are often overlooked or delayed (2).
Research studies have shown that prompt administration of
antidepressant therapy after a stroke can prevent the development of
PSD (7).
Additionally, antidepressant therapy can improve the prognosis of
stroke patients, including cognitive and executive functions, thereby
enhancing their quality of life (8).
It is worth noting that a randomized placebo-controlled trial has
established that the benefits of antidepressants can extend beyond
emotional symptoms. Patients who received antidepressants demonstrated
better motor recovery compared to the control group, leading to a
significant increase in the proportion of patients achieving partial or
complete living independence (9).
As a result, early detection of PSD and timely use of antidepressants
are crucial for effective stroke management. However, traditional
antidepressants often fail to meet clinical needs due to their slow
onset of action and adverse side effects, such as hepatotoxicity,
nephrotoxicity, gastrointestinal discomfort, cognitive decline, etc. (10).
An increasing number of studies have demonstrated the efficacy of
Botulinum Toxin A (BoNT-A) in the treatment of depression. Clinical
randomized controlled trials have consistently confirmed the safety and
effectiveness of BoNT-A as an antidepressant therapy (11).
Building upon this previous research, we recruited PSD patients who met
the inclusion criteria to receive BoNT-A for antidepressant treatment,
with the traditional antidepressant Sertraline serving as the control
group in our study.
