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卒中后抑郁（post‐stroke depression，PSD）是卒中患者最常见的神经精神并发症之一，发病率高达30%，对患者康复和生活质量都有显著负面影响。PSD发病机制复杂，涉及神经递质失衡、神经炎症反应、神经营养因子减少及下丘脑‐垂体‐肾上腺（hypothalamic‐pituitary‐adrena，HPA）轴功能异常等多种因素。治疗PSD的方法包括药物治疗、心理治疗、神经调节技术、中药治疗、运动疗法和社会经济支持等。药物治疗中，选择性5‐羟色胺再摄取抑制剂是首选，但需注意药物副作用；心理治疗如认知行为治疗（cognitive behavior therapy， CBT）和人际心理治疗（interpersonal psychotherapy， IPT）通过调整认知和改善人际关系来缓解症状；重复经颅磁刺激（repeated transcranial magnetic stimulation， rTMS）和经颅直流电刺激（transcranial direct current stimulation，tDCS）等神经调节技术显示出显著疗效；脑深部电刺激（deep brain stimulation， DBS）在难治性抑郁症中疗效较好，为PSD治疗提供参考。此外，脑机接口（brain‐computer interface，BMI）结合功能性电刺激（functional electrical stimulation，FES）在促进神经可塑性和功能恢复方面具有显著效果，中药和运动疗法也在改善PSD症状方面显示出潜力。影像学生物标志物在评估和优化治疗方案方面具有潜力。综合治疗策略结合多种方法，可为PSD患者提供更全面和有效的治疗方案。未来研究应继续探索这些方法的优化和个性化应用，以提高PSD患者的治疗效果和生活质量。本研究围绕PSD治疗的最新进展进行综述，为临床治疗PSD提供新思路和理论依据。
","endNoteUrl_en":"http://xuebao.sdfmu.edu.cn/EN/article/getTxtFile.do?fileType=EndNote&id=744","reference":"| 1 | Medeiros GC， Roy D， Kontos N， et al. Post-stroke depression： a 2020 updated review［J］. Gen Hosp Psychiatry， 2020， 66： 70. |
| 2 | Frank D， Gruenbaum BF， Zlotnik A， et al. Pathophysiology and current drug treatments for post-stroke depression： a review［J］. Int J Mol Sci， 2022， 23（23）： 15114. |
| 3 | Zhou H， Wei YJ， Xie GY. Research progress on post-stroke depression［J］. Exp Neurol， 2024， 373： 114660. |
| 4 | Zhan QY， Kong FY. Mechanisms associated with post-stroke depression and pharmacologic therapy［J］. Front Neurol， 2023， 14： 1274709. |
| 5 | 吕红， 赵凌霄， 闫咏梅. 卒中后抑郁中医治疗及其机制研究进展［J］. 现代中西医结合杂志， 2022， 31（6）： 872. |
| 6 | 湛清扬， 孔繁一， 吕亚男， 等. 脑卒中后抑郁发病机制的研究进展［J］. 中风与神经疾病杂志， 2022， 39（4）： 369. |
| 7 | 齐士魁， 高静， 余明月， 等. 脑卒中后抑郁发病机制的研究进展［J］. 卒中与神经疾病， 2022， 29（5）： 483. |
| 8 | Wijeratne T， Sales C. Understanding why post-stroke depression may be the norm rather than the exception： the anatomical and neuroinflammatory correlates of post-stroke depression［J］. J Clin Med， 2021， 10（8）： 1674. |
| 9 | Krick S， Koob JL， Latarnik S， et al. Neuroanatomy of post-stroke depression： the association between symptom clusters and lesion location［J］. Brain Commun， 2023， 5（5）： fcad275. |
| 10 | Guo JL， Wang JI， Sun W， et al. The advances of post-stroke depression： 2021 update［J］. J Neurol， 2022， 269（3）： 1236. |
| 11 | 何淑萍， 梁统婵， 施红英. 老年脑卒中后失能患者抑郁的影响因素分析及心理护理的应用效果［J］. 中国医药科学， 2022， 12（24）： 96. |
| 12 | Richter D， Charles James J， Ebert A， et al. Selective serotonin reuptake inhibitors for the prevention of post-stroke depression： a systematic review and meta-analysis［J］. J Clin Med， 2021， 10（24）： 5912. |
| 13 | Jorge RE， Robinson RG， Arndt S， et al. Mortality and poststroke depression： a placebo-controlled trial of antidepressants［J］. Am J Psychiatry， 2003， 160（10）： 1823. |
| 14 | Juangco DN， Ang J， Efendy F， et al. Selective serotonin reuptake inhibitors for prevention of post stroke depression： a meta-analysis （P7.132）［J］. Neurology， 2015， 84（ement）： P7.132. |
| 15 | Ried LD， Jia HG， Feng H， et al. Selective serotonin reuptake inhibitor treatment and depression are associated with poststroke mortality［J］. Ann Pharmacother， 2011， 45（7/8）： 888. |
| 16 | Legg LA， Tilney R， Hsieh CF， et al. Selective serotonin reuptake inhibitors （SSRIs） for stroke recovery［J］. Cochrane Database Syst Rev， 2019， 2019（11）： CD009286. |
| 17 | Mortensen JK， Andersen G. Pharmacological management of post-stroke depression： an update of the evidence and clinical guidance［J］. Expert Opin Pharmacother， 2021， 22（9）： 1157. |
| 18 | Sivolap YP， Damulin IV. Stroke and depression［J］. Neurosci Behav Physiol， 2020， 50（6）： 683. |
| 19 | Kamp CB， Petersen JJ， Faltermeier P， et al. Beneficial and harmful effects of tricyclic antidepressants for adults with major depressive disorder： a systematic review with meta-analysis and trial sequential analysis. BMJ Ment Health. 2024；27（1）：e300730. |
| 20 | Shabani M， Eshaghian M， Mazloomzadeh S. The effect of sertreline versus nortriptyline on quality of life and depression after stroke： a randomized double-blind controlled study［J］. J Adv Med Biomed Res， 2022， 30（141）： 319. |
| 21 | Chollet F， Acket B， Raposo N， et al. Use of antidepressant medications to improve outcomes after stroke［J］. Curr Neurol Neurosci Rep， 2013， 13（1）： 318. |
| 22 | Paolucci S. Advances in antidepressants for treating post-stroke depression［J］. Expert Opin Pharmacother， 2017， 18（10）： 1011. |
| 23 | Tsiurko BO， Pelepeichenko AY， Raskalei DV， et al. Drug therapy of post-stroke depression［J］. Int Neurol J， 2022， 8（86）： 81. |
| 24 | Li LT， Wang SH， Ge HY， et al. The beneficial effects of the herbal medicine free and easy wanderer plus （FEWP） and fluoxetine on post-stroke depression［J］. J Altern Complement Med， 2008， 14（7）： 841. |
| 25 | Kotov S， Isakova E， Egorova YV. Post-stroke depression and the abilities of antidepressants to enhance the effectiveness of neurorehabilitation［J］. Neurol， Neuropsychiatry， Psychosom， 2020， 12（6）： 110. |
| 26 | 孙彬，周燕玲，曾钢.认知行为治疗对卒中后抑郁疗效的网状Meta分析［J］.中华脑血管病杂志（电子版），2021，15（06）：407-413. |
| 27 | Kelley ME， Choi KS， Rajendra JK， et al. Establishing evidence for clinical utility of a neuroimaging biomarker in major depressive disorder： prospective testing and implementation challenges［J］. Biol Psychiatry， 2021， 90（4）： 236. |
| 28 | Tahmi M， Kane VA， Pavol MA， et al. Neuroimaging biomarkers of cognitive recovery after ischemic stroke［J］. Front Neurol， 2022， 13： 923942. |
| 29 | Livint Popa L， Chira D， D?bal? V， et al. Quantitative EEG as a biomarker in evaluating post-stroke depression［J］. Diagnostics （Basel）， 2022， 13（1）： 49. |
| 30 | Lorenz R， Johal M， Dick F， et al. A bayesian optimization approach for rapidly mapping residual network function in stroke［J］. Brain， 2021， 144（7）： 2120. |
| 31 | 袁雅晴， 王英， 陈丽萍. 6种艺术疗法对卒中后抑郁患者干预效果的网状Meta分析［J］. betway必威登陆网址 （betway.com ）学报， 2024， 45（3）： 139. |
| 32 | Hordacre B， Comacchio K， Williams L， et al. Repetitive transcranial magnetic stimulation for post-stroke depression： a randomised trial with neurophysiological insight［J］. J Neurol， 2021， 268（4）： 1474. |
| 33 | Shao D， Zhao ZN， Zhang YQ， et al. Efficacy of repetitive transcranial magnetic stimulation for post-stroke depression： a systematic review and meta-analysis of randomized clinical trials［J］. Braz J Med Biol Res， 2021， 54（3）： e10010. |
| 34 | Kim HK， Blumberger DM， Downar J， et al. Systematic review of biological markers of therapeutic repetitive transcranial magnetic stimulation in neurological and psychiatric disorders［J］. Clin Neurophysiol， 2021， 132（2）： 429. |
| 35 | Keser Z， Buchl SC， Seven NA， et al. Electroencephalogram （EEG） with or without transcranial magnetic stimulation （TMS） as biomarkers for post-stroke recovery： a narrative review［J］. Front Neurol， 2022， 13： 827866. |
| 36 | Li LX， Lu JK， Li BJ， et al. The optimum parameters and neuroimaging mechanism of repetitive transcranial magnetic stimulation to post-stroke cognitive impairment， a protocol of an orthogonally-designed randomized controlled trial［J］. PLoS One， 2022， 17（7）： e0271283. |
| 37 | Figee M， Riva-Posse P， Choi KS， et al. Deep brain stimulation for depression［J］. Neurotherapeutics， 2022， 19（4）： 1229. |
| 38 | Scangos KW， Makhoul GS， Sugrue LP， et al. State-dependent responses to intracranial brain stimulation in a patient with depression［J］. Nat Med， 2021， 27（2）： 229. |
| 39 | Wu YL， Mo JJ， Sui LS， et al. Deep brain stimulation in treatment-resistant depression： a systematic review and meta-analysis on efficacy and safety［J］. Front Neurosci， 2021， 15： 655412. |
| 40 | Fateeva VV， Kushnir AB， Grechko AV， et al. Rehabilitation of patients with post-stroke cognitive impairment using the P300-based brain-computer interface： results of a randomized controlled trial［J］. Zh Nevrol Psikhiatr Im S S Korsakova， 2023， 123（12/2）： 68. |
| 41 | Biasiucci A， Leeb R， Iturrate I， et al. Brain-actuated functional electrical stimulation elicits lasting arm motor recovery after stroke［J］. Nat Commun， 2018， 9（1）： 2421. |
| 42 | Frolov AA， Mokienko O， Lyukmanov R， et al. Post-stroke rehabilitation training with a motor-imagery-based brain-computer interface （BCI）-controlled hand exoskeleton： a randomized controlled multicenter trial［J］. Front Neurosci， 2017， 11： 400. |
| 43 | Jiang SL， Chen L， Wang ZP， et al. Application of BCI-FES system on stroke rehabilitation［C］//2015 7th International IEEE/EMBS Conference on Neural Engineering （NER）. Piscataway： IEEE， 2015： 1112. |
| 44 | Yawen G， Li W， Wenwen Z， et al. Research Progress of Traditional Chinese Medicine in the Treatment of Post-Stroke Depression ［J］. Academic Journal of Medicine & Health Sciences， 2023， 4（4）： 14-19. |
| 45 | Yang YH， Zhang M， Zhao JJ， et al. Effect of traditional Chinese medicine emotional therapy on post-stroke depression： a protocol for systematic review and meta-analysis［J］. Medicine （Baltimore）， 2021， 100（14）： e25386. |
| 46 | 焦敏， 苗帅， 徐晓燕. 乌灵胶囊联合黛力新治疗脑卒中后抑郁有效性和安全性的Meta分析［J］. betway必威登陆网址 （betway.com ）学报， 2021， 42（9）： 685. |
| 47 | Tang XQ， Liao RY， Zheng LJ， et al. Aerobic exercise reverses the NF-κB/NLRP3 inflammasome/5-HT pathway by upregulating irisin to alleviate post-stroke depression［J］. Ann Transl Med， 2022， 10（24）： 1350. |
| 48 | Taylor-Piliae RE， Morrison HW， Hsu CHP， et al. The feasibility of Tai Chi exercise as a beneficial mind-body intervention in a group of community-dwelling stroke survivors with symptoms of depression［J］. Evid Based Complement Alternat Med， 2021， 2021： 8600443. |
| 49 | Paprocka-Borowicz M， Wiatr M， Cia?owicz M， et al. Influence of physical activity and socio-economic status on depression and anxiety symptoms in patients after stroke［J］. Int J Environ Res Public Health， 2021， 18（15）： 8058. |
| 50 | Zhao L， Lyu X， Jiang H， et al. Musicokinetic and exercise therapies decrease the depression level of elderly patients undergoing post-stroke rehabilitation： the moderating effect of health regulatory focus［J］. Front Psychol， 2022， 13： 889510. |
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PDF(620 KB)
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卒中后抑郁治疗的新进展
New progress in the treatment of post-stroke depression
卒中后抑郁（post‐stroke depression，PSD）是卒中患者最常见的神经精神并发症之一，发病率高达30%，对患者康复和生活质量都有显著负面影响。PSD发病机制复杂，涉及神经递质失衡、神经炎症反应、神经营养因子减少及下丘脑‐垂体‐肾上腺（hypothalamic‐pituitary‐adrena，HPA）轴功能异常等多种因素。治疗PSD的方法包括药物治疗、心理治疗、神经调节技术、中药治疗、运动疗法和社会经济支持等。药物治疗中，选择性5‐羟色胺再摄取抑制剂是首选，但需注意药物副作用；心理治疗如认知行为治疗（cognitive behavior therapy， CBT）和人际心理治疗（interpersonal psychotherapy， IPT）通过调整认知和改善人际关系来缓解症状；重复经颅磁刺激（repeated transcranial magnetic stimulation， rTMS）和经颅直流电刺激（transcranial direct current stimulation，tDCS）等神经调节技术显示出显著疗效；脑深部电刺激（deep brain stimulation， DBS）在难治性抑郁症中疗效较好，为PSD治疗提供参考。此外，脑机接口（brain‐computer interface，BMI）结合功能性电刺激（functional electrical stimulation，FES）在促进神经可塑性和功能恢复方面具有显著效果，中药和运动疗法也在改善PSD症状方面显示出潜力。影像学生物标志物在评估和优化治疗方案方面具有潜力。综合治疗策略结合多种方法，可为PSD患者提供更全面和有效的治疗方案。未来研究应继续探索这些方法的优化和个性化应用，以提高PSD患者的治疗效果和生活质量。本研究围绕PSD治疗的最新进展进行综述，为临床治疗PSD提供新思路和理论依据。
Post stroke depression （PSD） is one of the most common neuropsychiatric complications in stroke patients. The incidence rate is as high as 30%， which has a significant impact on patients' rehabilitation and quality of life. Its pathogenesis is complex， involving multiple factors such as neurotransmitter imbalance， neuroinflammatory response， decreased neurotrophic factors， and abnormal HPA axis function.The methods for treating PSD include drug therapy， psychotherapy， neuromodulatory techniques， traditional Chinese medicine treatment， exercise therapy， and socio-economic support. In drug therapy， selective serotonin reuptake inhibitors are the first choice， but side effects should be noted.Psychological therapy such as cognitive-behavioral therapy and interpersonal psychotherapy improve symptoms by regulating cognition and interpersonal relationships.Neuroregulatory techniques such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation have shown significant therapeutic effects.The success of deep brain electrical stimulation in refractory depression provides a reference for PSD treatment. Additionally， brain-computer interface （BCI） combined with functional electrical stimulation （FES） has significant effects in promoting neural plasticity and functional recovery， and traditional Chinese medicine and exercise therapy have also shown potential in improving PSD symptoms. Imaging biomarkers have the potential to evaluate and optimize treatment plans. A comprehensive treatment strategy combined with multiple methods will provide a more comprehensive and effective treatment plan for PSD patients. Future research should continue to explore the optimization and personalized application of these methods to improve the treatment effectiveness and quality of life of PSD patients.This article reviews the latest progress in the treatment of PSD， providing new ideas and theoretical basis for clinical treatment of PSD.
卒中后抑郁/药物疗法/心理治疗/重复经颅磁刺激/经颅直流电刺激/脑深部电刺激
post-stroke depression/pharmacotherapy/psychotherapy/repetitive transcranial magnetic stimulation/transcranial direct current stimulation/deep brain stimulation
| 1 | Medeiros GC， Roy D， Kontos N， et al. Post-stroke depression： a 2020 updated review［J］.Gen Hosp Psychiatry，2020，66： 70. |
| 2 | Frank D， Gruenbaum BF， Zlotnik A， et al. Pathophysiology and current drug treatments for post-stroke depression： a review［J］.Int J Mol Sci，2022，23（23）： 15114. |
| 3 | Zhou H， Wei YJ， Xie GY. Research progress on post-stroke depression［J］.Exp Neurol，2024，373： 114660. |
| 4 | Zhan QY， Kong FY. Mechanisms associated with post-stroke depression and pharmacologic therapy［J］.Front Neurol，2023，14： 1274709. |
| 5 | 吕红， 赵凌霄， 闫咏梅. 卒中后抑郁中医治疗及其机制研究进展［J］.现代中西医结合杂志，2022，31（6）： 872. |
| 6 | 湛清扬， 孔繁一， 吕亚男， 等. 脑卒中后抑郁发病机制的研究进展［J］.中风与神经疾病杂志，2022，39（4）： 369. |
| 7 | 齐士魁， 高静， 余明月， 等. 脑卒中后抑郁发病机制的研究进展［J］.卒中与神经疾病，2022，29（5）： 483. |
| 8 | Wijeratne T， Sales C. Understanding why post-stroke depression may be the norm rather than the exception： the anatomical and neuroinflammatory correlates of post-stroke depression［J］.J Clin Med，2021，10（8）： 1674. |
| 9 | Krick S， Koob JL， Latarnik S， et al. Neuroanatomy of post-stroke depression： the association between symptom clusters and lesion location［J］.Brain Commun，2023，5（5）： fcad275. |
| 10 | Guo JL， Wang JI， Sun W， et al. The advances of post-stroke depression： 2021 update［J］.J Neurol，2022，269（3）： 1236. |
| 11 | 何淑萍， 梁统婵， 施红英. 老年脑卒中后失能患者抑郁的影响因素分析及心理护理的应用效果［J］.中国医药科学，2022，12（24）： 96. |
| 12 | Richter D， Charles James J， Ebert A， et al. Selective serotonin reuptake inhibitors for the prevention of post-stroke depression： a systematic review and meta-analysis［J］.J Clin Med，2021，10（24）： 5912. |
| 13 | Jorge RE， Robinson RG， Arndt S， et al. Mortality and poststroke depression： a placebo-controlled trial of antidepressants［J］.Am J Psychiatry，2003，160（10）： 1823. |
| 14 | Juangco DN， Ang J， Efendy F， et al. Selective serotonin reuptake inhibitors for prevention of post stroke depression： a meta-analysis （P7.132）［J］.Neurology，2015，84（ement）： P7.132. |
| 15 | Ried LD， Jia HG， Feng H， et al. Selective serotonin reuptake inhibitor treatment and depression are associated with poststroke mortality［J］.Ann Pharmacother，2011，45（7/8）： 888. |
| 16 | Legg LA， Tilney R， Hsieh CF， et al. Selective serotonin reuptake inhibitors （SSRIs） for stroke recovery［J］.Cochrane Database Syst Rev，2019，2019（11）： CD009286. |
| 17 | Mortensen JK， Andersen G. Pharmacological management of post-stroke depression： an update of the evidence and clinical guidance［J］.Expert Opin Pharmacother，2021，22（9）： 1157. |
| 18 | Sivolap YP， Damulin IV. Stroke and depression［J］.Neurosci Behav Physiol，2020，50（6）： 683. |
| 19 | Kamp CB， Petersen JJ， Faltermeier P， et al. Beneficial and harmful effects of tricyclic antidepressants for adults with major depressive disorder： a systematic review with meta-analysis and trial sequential analysis.BMJ Ment Health.2024；27（1）：e300730. |
| 20 | Shabani M， Eshaghian M， Mazloomzadeh S. The effect of sertreline versus nortriptyline on quality of life and depression after stroke： a randomized double-blind controlled study［J］.J Adv Med Biomed Res，2022，30（141）： 319. |
| 21 | Chollet F， Acket B， Raposo N， et al. Use of antidepressant medications to improve outcomes after stroke［J］.Curr Neurol Neurosci Rep，2013，13（1）： 318. |
| 22 | Paolucci S. Advances in antidepressants for treating post-stroke depression［J］.Expert Opin Pharmacother，2017，18（10）： 1011. |
| 23 | Tsiurko BO， Pelepeichenko AY， Raskalei DV， et al. Drug therapy of post-stroke depression［J］.Int Neurol J，2022，8（86）： 81. |
| 24 | Li LT， Wang SH， Ge HY， et al. The beneficial effects of the herbal medicine free and easy wanderer plus （FEWP） and fluoxetine on post-stroke depression［J］.J Altern Complement Med，2008，14（7）： 841. |
| 25 | Kotov S， Isakova E， Egorova YV. Post-stroke depression and the abilities of antidepressants to enhance the effectiveness of neurorehabilitation［J］.Neurol， Neuropsychiatry， Psychosom，2020，12（6）： 110. |
| 26 | 孙彬，周燕玲，曾钢.认知行为治疗对卒中后抑郁疗效的网状Meta分析［J］.中华脑血管病杂志（电子版），2021，15（06）：407-413. |
| 27 | Kelley ME， Choi KS， Rajendra JK， et al. Establishing evidence for clinical utility of a neuroimaging biomarker in major depressive disorder： prospective testing and implementation challenges［J］.Biol Psychiatry，2021，90（4）： 236. |
| 28 | Tahmi M， Kane VA， Pavol MA， et al. Neuroimaging biomarkers of cognitive recovery after ischemic stroke［J］.Front Neurol，2022，13： 923942. |
| 29 | Livint Popa L， Chira D， D?bal? V， et al. Quantitative EEG as a biomarker in evaluating post-stroke depression［J］.Diagnostics （Basel），2022，13（1）： 49. |
| 30 | Lorenz R， Johal M， Dick F， et al. A bayesian optimization approach for rapidly mapping residual network function in stroke［J］.Brain，2021，144（7）： 2120. |
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