Effectiveness of non-pharmacological interventions for treating post-stroke depressive symptoms: Systematic review and meta-analysis of randomized controlled trials.

ObjectiveTo compare the effectiveness of non-pharmacological interventions on depressive symptoms in people after stroke.Data sourcesA literature search was performed through databases from January 2000 to August 2018: MEDLINE; CINAHL Plus; Scopus; Academic Search Complete; Cochrane Central Register of Controlled Trials; Scopus; and Library, Information Science and Technology Abstracts. Search terms included depression, stroke, non-pharmacologic, and intervention.Study selectionWe included randomized controlled trials comparing non-pharmacological interventions to controls for depressive symptoms in people after stroke. Of 1703 identified articles, 22 trials were included in narrative synthesis, of which 13 were eligible for meta-analysis.Data extractionTwo reviewers extracted characteristics of participants, interventions, and results from all included trials.Data synthesisThirteen interventions were categorized into four types: complementary and alternative therapy (five trials, n=228), exercise (four trials, n=263), psychosocial therapy (two trials, n=216), and multifactorial therapy (two trials, n=358). Overall beneficial effects of non-pharmacological interventions on depressive symptoms were found both post-intervention (effect size [ES] = -0.24, 95% confidence Interval [CI]: -0.37 to -0.11, p pp p ConclusionsComplementary and alternative therapy and psychosocial therapy appear to be promising strategies for improving post-stroke depression. Future studies target a personalized approach for people with specific conditions such as cognitive impairment.