Effectiveness of Non-Pharmacological Interventions for Treating Post-Stroke Depressive Symptoms: Systematic Review and Meta-Analysis of Randomized Controlled Trials

OBJECTIVE: To compare the effectiveness of non-pharmacological interventions on depressive symptoms in people after stroke. DATA SOURCES: A literature search was performed through the following 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 SELECTION: We included randomized controlled trials comparing non-pharmacological interventions to control conditions for depressive symptoms in people following stroke. Of 1703 identified articles, 22 trials were included in narrative synthesis, of which 13 were eligible for meta-analysis. All trials were included once their outcome assessments were blinded. DATA EXTRACTION: Two reviewers were involved in the data extraction process. Characteristics of participants, interventions, and methods and results (means and standard deviations) were extracted from all included trials. DATA SYNTHESIS: Thirteen non-pharmacological interventions were categorized into four types: complementary and alternative therapy (five trials, 228 participants), exercise (four trials, 263 participants), psychosocial therapy (two trials, 216 participants), and multifactorial therapy (two trials, 358 participants). 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 < 0.05) and at follow-up (ES = −0.22, CI: −0.36 to −0.07, p < 0.05). We found individual beneficial effects for complementary and alternative therapy (ES = −0.29, CI: −0.55 to −0.02, p < 0.05) and psychosocial therapy (ES = − 0.33, CI: −0.60 to −0.06, p < 0.05) post-intervention. CONCLUSIONS: Non-pharmacological interventions can be effective in addressing depressive symptoms in people after stroke. Complementary and alternative therapy and psychosocial therapy appear to be promising strategies for improving post-stroke depressive symptoms. Future studies are required to identify a personalized approach for people with specific conditions such as cognitive impairment.