NORTRIPTYLINE TREATMENT OF POST-STROKE DEPRESSION: A DOUBLE-BLIND STUDY Adverse reactions to antidepressants. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both Antidepressant use and risk of incident cardiovascular morbidity and mortality among postmenopausal women in the Women's Health Initiative study. The synergistic effect of acupuncture and computer-based cognitive training on post-stroke cognitive dysfunction: a study protocol for a randomized controlled trial of 2 × 2 factorial design Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial A Population-Based Cohort Study on the Ability of Acupuncture to Reduce Post-Stroke Depression Effective Treatment of Poststroke Depression With the Selective Serotonin Reuptake Inhibitor Citalopram A pilot controlled trial of a combination of dense cranial electroacupuncture stimulation and body acupuncture for post-stroke depression Rehabilitation for post-stroke cognitive impairment: an overview of recommendations arising from systematic reviews of current evidence [Acupuncture combined with auricular point sticking therapy for post stroke depression:a randomized controlled trial]. [Efficacy on post-stroke depression treated with acupuncture at the acupoints based on ziwuliuzhu and prozac]. Electroacupuncture improves cognitive function through Rho GTPases and enhances dendritic spine plasticity in rats with cerebral ischemia-reperfusion. [Effect of acupuncture on expression of brain-derived neurotrophic factor gene and protein in frontal cortex and hippocampus of depression rats]. [Post-stroke depression treated with acupuncture and moxibustion: an evaluation of therapeutic effect and safety]. Electroacupuncture Ameliorates Cognitive Impairment and Spontaneous Low-Frequency Brain Activity in Rats with Ischemic Stroke. Trajectory of Cognitive Decline After Incident Stroke.
The efficacy of nortriptyline in the treatment of post-stroke depression was assessed by a double-blind study in thirty-four patients . Half of the patients had major depression .  There was a significantly greater improvement in depression in patients treated with  nortriptyline  than in a similar group of placebo-treated patients . Depression was measured by the Hamilton depression scale , Zung depression scale , present state examination , and an overall depression scale . Successfully treated patients had serum nortriptyline levels in the therapeutic range . Post-stroke depressions are common , severe , and longst and ing , and the demonstrated efficacy of nortriptyline provides an important addition to the treatments available for stroke patients BACKGROUND Adverse drug reactions are important determinants of non-adherence to antidepressant treatment , but their assessment is complicated by overlap with depressive symptoms and lack of reliable self-report measures . AIMS To evaluate a simple self-report measure and describe adverse reactions to antidepressants in a large sample . METHOD The newly developed self-report Antidepressant Side-Effect Checklist and the psychiatrist-rated UKU Side Effect Rating Scale were repeatedly administered to 811 adult participants with depression in a part-r and omised multicentre open-label study comparing escitalopram and nortriptyline .  RESULTS There was good agreement between self-report and psychiatrists ' ratings . Most complaints listed as adverse reactions in people with depression were more common when they were medication-free rather than during their treatment with antidepressants . Dry mouth ( 74 % ) , constipation ( 33 % ) and weight gain ( 15 % ) were associated with nortriptyline treatment . Diarrhoea ( 9 % ) , insomnia ( 36 % ) and yawning ( 16 % ) were more common during treatment with escitalopram .  Problems with urination and drowsiness predicted discontinuation of nortriptyline .  Diarrhoea and decreased appetite predicted discontinuation of escitalopram . CONCLUSIONS Adverse reactions to antidepressants can be reliably assessed by self-report . Attention to specific adverse reactions may improve adherence to antidepressant treatment The number of published systematic review s of studies of healthcare interventions has increased rapidly and these are used extensively for clinical and policy decisions . Systematic review s are subject to a range of biases and increasingly include non-r and omised studies of interventions . It is important that users can distinguish high quality review s. Many instruments have been design ed to evaluate different aspects of review s , but there are few comprehensive critical appraisal instruments . AMSTAR was developed to evaluate systematic review s of r and omised trials . In this paper , we report on the updating of AMSTAR and its adaptation to enable more detailed assessment of systematic review s that include r and omised or non-r and omised studies of healthcare interventions , or both . With moves to base more decisions on real world observational evidence we believe that AMSTAR 2 will assist decision makers in the identification of high quality systematic review s , including those based on non-r and omised studies of healthcare interventions BACKGROUND Antidepressants are commonly prescribed medications , but their effect on cardiovascular morbidity and mortality remains unclear . METHODS Prospect i ve cohort study of 136 293 community-dwelling postmenopausal women in the Women 's Health Initiative ( WHI ) . Women taking no antidepressants at study entry and who had at least 1 follow-up visit were included . Cardiovascular morbidity and all-cause mortality for women with new antidepressant use at follow-up ( n = 5496 ) were compared with those characteristics for women taking no antidepressants at follow-up ( mean follow-up , 5.9 years ) . RESULTS Antidepressant use was not associated with coronary heart disease ( CHD ) .  Selective serotonin reuptake inhibitor ( SSRI ) use was associated with increased stroke risk ( hazard ratio [HR],1.45 , [ 95 % CI , 1.08 - 1.97 ] ) and all-cause mortality ( HR,1.32 [ 95 % CI , 1.10 - 1.59 ] ) . Annualized rates per 1000 person-years of stroke with no antidepressant use and SSRI use were 2.99 and 4.16 , respectively , and death rates were 7.79 and 12.77 . Tricyclic antidepressant ( TCA ) use was associated with increased risk of all-cause mortality ( HR,1.67 [ 95 % CI , 1.33 - 2.09 ] ; annualized rate , 14.14 deaths per 1000 person-years ) . There were no significant differences between SSRI and TCA use in risk of any outcomes . In analyses by stroke type , SSRI use was associated with incident hemorrhagic stroke ( HR , 2.12 [ 95 % CI , 1.10 - 4.07 ] ) and fatal stroke ( HR , 2.10 [ 95 % CI , 1.15 - 3.81 ] ) . CONCLUSIONS In postmenopausal women , there were no significant differences between SSRI and TCA use in risk of CHD , stroke , or mortality . Antidepressants were not associated with risk of CHD .  Tricyclic antidepressants and SSRIs may be associated with increased risk of mortality , and SSRIs with increased risk of hemorrhagic and fatal stroke , although absolute event risks are low . These findings must be weighed against quality of life and established risks of cardiovascular disease and mortality associated with untreated depression Background Stroke is one of the most common causes of cognitive impairment . Up to 75 % of stroke survivors may be considered to have cognitive impairment , which severely limit individual autonomy for successful reintegration into family , work and social life . The clinical efficacy of acupuncture with Baihui ( DU20 ) and Shenting ( DU24 ) in stroke and post-stroke cognitive impairment has been previously demonstrated . Computer-assisted cognitive training is part of conventional cognitive rehabilitation and has also shown to be effective in improvement of cognitive function of affected patients . However , the cognitive impairment after stroke is so complexity that one single treatment can not resolve effectively . Besides , the effects of acupuncture and RehaCom cognitive training have not been systematic ally compared , nor has the possibility of a synergistic effect of combination of the two therapeutic modalities been evaluated . Our primary aim of this trial is to evaluate the synergistic effect of acupuncture and RehaCom cognitive training  on cognitive dysfunction after stroke . Method / Design A r and omized controlled trial of 2 × 2 factorial design will be conducted in the Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine . A total of 240 patients with cognitive dysfunction after stroke who meet the eligibility criteria will be recruited and r and omized into RehaCom training group , acupuncture group , a combination of both or control group in a 1:1:1:1 ratio . All patients will receive conventional treatment . The interventions will last for 12 weeks ( 30 min per day , Monday to Friday every week ) . Evaluations will be conducted by blinded assessors at baseline and again at 4 , 8 and 12 weeks . Outcome measurements include mini – mental state examination ( MMSE ) , Montreal cognitive assessment s ( MoCA ) , functional independence measure scale ( FIM ) and adverse events . Discussion The results of this trial are expected to clarify the synergistic effect of acupuncture and RehaCom cognitive training on cognitive dysfunction after stroke . Furthermore , to confirm whether combined or alone of acupuncture and RehaCom cognitive training , is more effective than conventional treatment in the management of post-stroke cognitive dysfunction . Trial registration Chinese Clinical Trial Registry : ChiCTR-TRC-13003704 . Registration date : 4 September , 2013 BACKGROUND Hemiplegia and hemiparesis are the most common deficits caused by stroke . A few small clinical trials suggest that fluoxetine enhances motor recovery but its clinical efficacy is unknown . We therefore aim ed to investigate whether fluoxetine would enhance motor recovery if given soon after an ischaemic stroke to patients who have motor deficits . METHODS In this double-blind , placebo-controlled trial , patients from nine stroke centres in France who had ischaemic stroke and hemiplegia or hemiparesis , had Fugl-Meyer motor scale ( FMMS ) scores of 55 or less , and were aged between 18 years and 85 years were eligible for inclusion . Patients were r and omly assigned , using a computer r and om-number generator , in a 1:1 ratio to fluoxetine ( 20 mg once per day , orally ) or placebo for 3 months starting 5 - 10 days after the onset of stroke . All patients had physiotherapy . The primary outcome measure was the change on the FMMS between day 0 and day 90 after the start of the study drug . Participants , carers , and physicians assessing the outcome were masked to group assignment . Analysis was of all patients for whom data were available ( full analysis set ) . This trial is registered with Clinical Trials.gov , number NCT00657163 . FINDINGS 118 patients were r and omly assigned to fluoxetine ( n=59 ) or placebo ( n=59 ) , and 113 were included in the analysis ( 57 in the fluoxetine group and 56 in the placebo group ) . Two patients died before day 90 and three withdrew from the study . FMMS improvement at day 90 was significantly greater in the fluoxetine group ( adjusted mean 34·0 points [ 95 % CI 29·7 - 38·4 ] ) than in the placebo group ( 24·3 points [ 19·9 - 28·7 ] ; p=0·003 ) . The main adverse events in the fluoxetine and placebo groups were hyponatraemia ( two [ 4 % ] vs two [ 4 % ] ) , transient digestive disorders including nausea , diarrhoea , and abdominal pain ( 14 [ 25 % ] vs six [ 11 % ] ) , hepatic enzyme disorders ( five [ 9 % ] vs ten [ 18 % ] ) , psychiatric disorders ( three [ 5 % ] vs four [ 7 % ] ) , insomnia ( 19 [ 33 % ] vs 20 [ 36 % ] ) , and partial seizure ( one [ < 1 % ] vs 0 ) . INTERPRETATION In patients with ischaemic stroke and moderate to severe motor deficit , the early prescription of fluoxetine with physiotherapy enhanced motor recovery after 3 months . Modulation of spontaneous brain plasticity by drugs is a promising pathway for treatment of patients with ischaemic stroke and moderate to severe motor deficit . FUNDING Public French National Programme for Clinical Research Objective : Post-stroke depression ( PSD ) is common and has a negative impact on recovery . Although many stroke patients in Taiwan have used acupuncture as a supplementary treatment for reducing stroke comorbidities , little research has been done on the use of acupuncture to prevent PSD . Accordingly , our goal is to investigate whether using acupuncture after a stroke can reduce the risk of PSD . Method : This population -based cohort study examined medical cl aims data from a r and om sample of 1 million insured people registered in Taiwan . Newly diagnosed stroke patients in the period 2000–2005 were recruited in our study . All patients were followed through to the end of 2007 to determine whether they had developed symptoms of depression . A Cox proportional hazard model was used to estimate the relative risk of depression in patients after being diagnosed as having had a stroke , with a focus on the differences in those with and without acupuncture treatment . Results : A total of 8487 newly-diagnosed stroke patients were included in our study ; of these , 1036 patients received acupuncture more than five times following their stroke , 1053 patients  received acupuncture 1–5 times following their stroke and 6398 did not receive acupuncture . After we controlled for potential confounders ( e.g. , age , sex , insurance premium , residential area , type of stroke , length of hospital stay , stroke severity index , rehabilitation and major illness – related depression ) , we found that acupuncture after stroke significantly reduced the risk of depression , with a hazard ratio ( HR ) of 0.475 ( 95 % CI , 0.389–0.580 ) in frequent acupuncture users and 0.718 ( 95 % CI , 0.612–0.842 ) in infrequent acupuncture users , indicating that acupuncture may lower the risk of PSD by an estimated 52.5 % in frequent users and 28.2 % in infrequent users . Conclusions : After we controlled for potential confounders , it appears that using acupuncture after a stroke lowers the risk of depression . Additional strictly- design ed r and omized controlled trials are needed to better underst and the specific mechanisms relating acupuncture to health outcomes Background and Purpose The aim of the study was to investigate the efficacy and safety of the selective serotonin reuptake inhibitor citalopram in treating poststroke depression , since available treatments are usually poorly tolerated . Methods A 6-week double-blind , placebo-controlled trial was undertaken . Diagnosis and outcome were determined using the Hamilton Depression Scale , and unwanted effects were measured using the UKU side effect rating scale .  Sixtysix consecutive depressed patients from an unselected population of 285 stroke patients aged 25 to 80 years entered the trial 2 to 52 weeks after stroke . They were assigned to equally sized treatment and placebo groups . The initial level of depression was comparable in the two groups ( mean baseline Hamilton Depression scores , 19.4 and 18.9 , respectively ) . Demographic parameters were also comparable in the two groups . Results Significantly greater improvement was seen in patients treated with citalopram ( 10 to 40 mg/d ) for 3 and 6 weeks , both when including all patients ( intention-to-treat analysis , p<.05 ) and excluding patients who dropped out during the first 3 weeks ( efficacy analysis , P<.005 ) . Half of the 28 patients who entered the trial 2 to 6 weeks after stroke recovered within 1 month , independent of the treatment given . This indicates a high degree of spontaneous recovery in the early phase after stroke . In contrast , recovery was infrequent in placebo group patients who became depressed 7 weeks or more after stroke . No serious side effects related to the treatment were detected ; those present were mild and usually transient . Conclusions This trial demonstrates that the selective serotonin reuptake inhibitor citalopram offers an advantageous new treatment of poststroke depression that is both safe and effective Background Our previous studies have demonstrated the treatment benefits of dense cranial electroacupuncture stimulation ( DCEAS ) , a novel brain stimulation therapy in patients with major depression , postpartum depression and obsessive-compulsive disorder . The purpose of the present study was to further evaluate the effectiveness of DCEAS combined with body acupuncture and selective serotonin reuptake inhibitors ( SSRIs ) in patients with post-stroke depression ( PSD ) . Methods In a single-blind , r and omized controlled trial , 43 patients with PSD were r and omly assigned to 12 sessions of DCEAS plus SSRI plus body electroacupuncture ( n = 23 ) , or sham ( non-invasive cranial electroacupuncture , n-CEA ) plus SSRI plus body electroacupuncture ( n = 20 ) for 3 sessions per week over 4 weeks . Treatment outcomes were measured using the 17-item Hamilton Depression Rating Scale ( HAMD-17 ) , the Clinical Global Impression - Severity scale ( CGI-S ) and Barthel Index ( BI ) , a measure used to evaluate movement ability associated with daily self-caring activity . Results DCEAS produced a significantly greater reduction of both HAMD-17 and CGI-S as early as week 1 and CGI-S at endpoint compared to n-CEA , but subjects of n-CEA group exhibited a significantly greater improvement on BI at week 4 than DCEAS . Incidence of adverse events was not different in the two groups . Conclusions These results indicate that DCEAS could be effective in reducing stroke patients ’ depressive symptoms  . Superficial electrical stimulation in n-CEA group may be beneficial in improving movement disability of stroke patients . A combination of DCEAS and body acupuncture can be considered a treatment option for neuropsychiatric sequelae of stroke . Trial registration http://www . clinical trials.gov , NCT01174394 Background : Although cognitive impairments are common following stroke , there is considerable uncertainty about the types of interventions that can reduce activity restrictions and improve quality of life . Indeed , a recent project to identify priorities for research into life after stroke determined that the top priority for patients , carers and health professionals was how to improve cognitive impairments . Objective : To provide an overview of the evidence for the effectiveness of cognitive rehabilitation for patients with stroke and to determine the main gaps in the current evidence base . Methods : Evidence was synthesis ed for the six Cochrane review s relating to rehabilitation for post-stroke cognitive impairment and any subsequently published r and omized controlled trials to February 2012 . Results : Data arising from 44 trials involving over 1500 patients was identified . Though there was support for the effectiveness of  cognitive rehabilitation for some cognitive impairments , significant gaps were found in the current evidence base . All of the Cochrane review s identified major limitations within the evidence they identified . Conclusions : There is currently insufficient research evidence , or evidence of insufficient quality , to support clear recommendations for clinical practice . Recommendations are made as to the research required to strengthen the evidence base , and so facilitate the delivery of effective interventions to individuals with cognitive impairment after stroke OBJECTIVE To observe the clinical effects of acupuncture combined with auricular point sticking based on the western medication for post stroke depression ( PSD ) . METHODS Sixty patients with PSD were r and omly assigned into an acupuncture plus auricular application group ( a combination group ) and a medication group , 30 cases in each one . 20 mg paroxetine hydrochloride was prescribed orally in the medication group , once a day for continuous 8 weeks . Based on the above treatment , 30-minute acupuncture was used in the combination group for 8 weeks at Baihui ( GV 20 ) , Sishencong ( EX-HN 1 ) , Shenting ( GV 24 ) , Yintang ( GV 29 ) , Shenmen ( HT 7 ) , Neiguan ( PC 6 ) , Taichong ( LR 3 ) , Hegu ( LI 4 ) , Zusanli ( ST 36 ) , Sanyinjiao ( SP 6 ) and Fenglong ( ST 40 ) , once the other day and three times a week . Auricular point sticking therapy for 8 weeks was applied at shenmen ( TF4 ) , pizhixia ( AT4 ) , xin ( CO15 ) , and gan ( CO12 ) , with pressing 3 times a day and once 3 - 5 days . The total score and each factor scores of Hamilton 's depression scale ( HAMD ) were observed in the two groups before and after treatment , and Asberg 's antidepressant side-effect rating scale ( SERS ) and clinical effect were evaluated . RESULTS After treatment , the total HAMD scores of the two groups decreased compared with those before treatment ( both P<0.05 ) , with better effect in the combination group ( P<0.05 ) . The scores of the combination group after treatment were lower than those in the medication group , including the anxiety/somatization factor , sleep disturbance factor , hopelessness factor ( all P<0.05 ) . The total effective rate of the combination group was 86.7 % ( 26/30 ) , which was better than 66.7 % ( 20/30 ) of the medication group ( P<0.05 ) . The SERS score of the combination group was lower than that of the medication group ( P<0.05 ) . CONCLUSIONS Acupuncture combined with auricular point sticking can improve the clinical symptoms and are effective and safe for PSD OBJECTIVE To observe the effects on post-stroke depression  treated with acupuncture at the acu points based on ziwuliuzhu ( the midnight-noon ebb-flow theory ) . METHODS Ninety-three patients were r and omized into a comprehensive group , a  ziwuliuzhu  group and a  prozac group  , 31 cases in each group . In the ziwuliuzhu group , acupuncture was applied to the acupoints based on ziwuliuzhu , once a day , 5 times in a week . In the prozac group , fluoxertine hydrochloride ( prozac ) was prescribed for oral administration , once a day , 20 mg each time . In the comprehensive group , acupuncture based on ziwuliuzhu combined with the oral administration of prozac were adopted and the treatment frequency was the same as the ziwuliuzhu group and the prozac group . The 4-week treatment was taken as one session in the three groups and 6 sessions were required totally . The clinical efficacy and the Hamilton depression rating scale ( HAMD ) score and the adverse reaction were compared among the 3 groups . RESULTS The total effective rate was 96.8 % ( 30/31 ) in the comprehensive group , better than 83.9 % ( 26/31 ) in the ziwuliuzhu group and 80 . 6 % ( 25/31 ) in the prozac group ( both P<0.05 ) . In 4 , 12 and 24 weeks of treatment , HAMD score was lower significantly than that before the treatment in the three groups ( all P<0.05 ) , and the score in the comprehensive group at each time point after treatment was lower than the other two groups ( all P<0.05 ) . In 4 and 12 weeks of treatment , there were not different significantly between the ziwuliuzhu group and the prozac group ( both P>0.05 ) . In 24 weeks of treatment , HAMD score in the ziwuliuzhu group was lower than that in the prozac group ( P<0.05 ) . For the adverse reaction , there were 2 cases in the comprehensive group , 6 cases in the prozac group and 0 case in the ziwzuliuzhu group . CONCLUSION The comprehensive therapy of acupuncture at the acupoints based on ziwuliuzhu and oral administration of prozac is superior to either the simple oral administration of prozac or the ziwuliuzhu acu-puncture in terms of clinical efficacy and the improvements in depressive state . Regarding the clinical efficacy , the impact of simple ziwuliuzhu acupuncture is not different significantly as compared with the simple oral administration of prozac , but it is better than the simple oral administration of prozac in terms of the long-term HAMD score and safety The aim of the present study was to evaluate the effect of  electroacupuncture ( EA ) on cognitive function  following cerebral ischemia‑reperfusion ( I/R ) injury , and to clarify the mechanism through which Rho GTPase is associated with EA analgesia modulation of dendritic spine plasticity . Rats were r and omly divided into three groups : The sham surgery group , the middle cerebral artery occlusion ( MCAO ) model of ischemia group , and the MCAO with EA ( MCAO+EA ) treatment group . The MCAO+EA group received treatment with EA at points of Baihui ( DU20 ) and Shenting ( DU24 ) following surgery . It was demonstrated that treatment with EA significantly ( P<0.05 ) protected the cognitive function of rats from impairment caused by cerebral I/R injury . Furthermore , EA treatment increased the density of dendritic spines in the hippocampus of cerebral I/R‑injured rats . Simultaneously , EA  increased the expression of cell division cycle 42 , Ras‑related C3 botulinum toxin substrate 1 and F‑actin proteins . By contrast , EA treatment inhibited the expression of Ras homologous member A. Collectively , these findings suggest that Rho GTPases and dendritic spine plasticity are critical in mediating the effects of EA treatment at the points of Shenting and Baihui , and that EA protects against impairment of cognitive function following ischemic stroke OBJECTIVE To observe the influence of acupuncture of " Baihui " ( GV 20 ) to " Yintang " ( EX-HN 3 ) and unilateral " Neiguan " ( PC 6 ) on the expression of brain-derived neurotrophic factor ( BDNF ) gene and protein in the prefrontal cortex and hippocampus in chronic stress-induced depression rats . METHODS Sprague-Dawley rats were r and omly divided into four groups ( 6 rats/group ) : control , control + acupuncture , model , and model + acupuncture . Depression model was established by giving the rats with repeated abstinence of food and water , illumination at night , forced cold water-swimming , vibration , tail-clamping , constraint and raising alone for 28 days . Acupuncture was applied to " Baihui " ( GV 20 ) to " Yintang " ( EX-HN 3 ) and unilateral " Neiguan"(PC 6 ) once every other day for 28 days . The expression levels of BDNF mRNA and protein of the frontal cortex and hippocampus tissues were detected by real-time fluorescence quantitative PCR and Western blot methods , separately . RESULTS Compared with the control group , the expression levels of BDNF mRNA and protein in the prefrontal cortex and hippocampus were significantly decreased in the model group ( P < 0.01 , P < 0.05 ) . Whereas compared with the model group , BDNF mRNA and protein expression levels in the prefrontal cortex and hippocampus were significantly upregulated in the model + acupuncture group ( P < 0.05 , P < 0.01 ) . No significant differences were found between the control and control + acupuncture groups in the expression levels of cortical and hippocampal BDNF mRNA and protein ( P > 0.05 ) . CONCLUSION Acupuncture can effectively reverse chronic stress-induced down-regulation of BDNF mRNA and protein expression in the frontal cortex and hippocampus in depression rats , which may contribute to its effect in anti-depression by protecting the regeneration of neurons OBJECTIVE To evaluate the efficacy and safety of acupuncture and moxibustion in the treatment of post-stroke depression ( PSD ) by regulating the liver and strengthening the root prescription . METHODS In light of the r and om controlled trial principle , 123 cases were r and omized into an acupuncture-moxibustion group ( 42 cases ) , a medication group ( 40 cases ) and an acupuncture + medication group ( 41 cases ) . In the acupuncture-moxibustion group , the therapy of regulating the liver and strengthening the root was applied . Acupuncture was given at Hegu ( LI 4 ) , Taichong ( LR 3 ) , Baihui ( GV 20 , Yintang ( GV 29 ) , etc . The granule moxibustion was applied at Zhongwan ( CV 12 ) , Xiawan ( CV 10 ) , Guanyuan ( CV 4 ) and Qihai ( CV 6 ) . The treatment was given once a day and stopped in weekend . In the medication group , paroxetine hydrochloride tablets were prescribed for oral administration , 20 mg each day after breakfast . In the acupuncture + medication group , the therapies were adopted as the acupuncture-moxibustion group and the medication group . In the 2nd and 4th week of treatment , HAMD was used as the primary index and Barthel index as the secondary one for the efficacy assessment in the three groups respectively . The spleen and stomach syndrome scale of TCM was used for the assessment of TCM syndrome efficacy . Treatment emergent symptom scale ( TESS ) was applied for the safety assessment . RESULTS In the 4th week of treatment , the markedly effective rates were 69.0 % ( 29/42 ) , 65.0 % ( 26/40 ) and 70.7 % ( 29/41 ) in the acupuncture-moxibustion group , the medication group and the acupuncture + medication group respectively . The efficacies of anti-depression were similar in comparison among groups ( P > 0.05 ) . In the 2nd week of treatment , the improvement of HAMD score was significant in the acupuncture + medication group as compared with that before treatment and in comparison with the medication group ( P < 0.05 , P < 0.01 ) . As for improving Barthel index , reducing the spleen and stomach symptom score of TCM and decreasing the score of TESS , the results in the acupuncture-moxibustion group and the acupuncture + medication group were superior to those in the medication group ( P < 0.05 , P < 0.01 ) . CONCLUSION The therapy of acupuncture and moxibustion with regulating the liver and strengthening the root achieves the definite efficacy of anti-depression and presents the quite high safety in treatment BACKGROUND To evaluate whether electroacupuncture ( EA ) at Baihui ( DU20 ) and Shenting ( DU24 ) acupoints could improve cognitive function and enhance spontaneous low-frequency brain activity in rats with ischemic stroke . METHODS Total 36 rats were r and omly divided into 3 groups-the sham surgery ( Sham ) group , the middle cerebral artery occlusion induced cognitive deficit ( MICD ) group , and the MICD with EA ( MICD + EA ) treatment group . The rats in MICD + EA group received EA treatment at DU20 and DU24 acupoints for 14 consecutive days after the surgery . The Morris water maze test was performed to assess the spatial learning and memory ability of the rats . Magnetic resonance imaging ( MRI ) was used to investigate the infa rct ion volume and spontaneous low-frequency brain activity of each group . RESULTS After EA for 14 days , the learning and memory ability of the MICD rats was improved , and the brain infa rct ion volume was reduced . Furthermore , basing on the fMRI amplitude of low-frequency fluctuation ( ALFF ) analysis , the decreased ALFF of the MICD rats was found in auditory cortex , cingulate gyrus , lateral nucleus group of dorsal thalamus , hippocampus , motor cortex , prelimbic cortex , retrosplenial cortex , and sensory cortex compared with the rats in sham group . However , these suppressive regions were notably attenuated after EA treatment . CONCLUSIONS Our results suggested that EA at DU20 and DU24 acupoints could ameliorate cognitive impairment in rats with ischemic stroke , and the protective effect of EA may attribute to reactivating the cognition-related brain regions , such as hippocampus , retrosplenial cortex , cingulate gyrus , prelimbic cortex , and sensory cortex IMPORTANCE Cognitive decline is a major cause of disability in stroke survivors . The magnitude of survivors ' cognitive changes after stroke is uncertain . OBJECTIVE To measure changes in cognitive function among survivors of incident stroke , controlling for their prestroke cognitive trajectories . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve study of 23,572 participants 45 years or older without baseline cognitive impairment from the Reasons for Geographic and Racial Differences in Stroke ( REGARDS ) cohort , residing in the continental United States , enrolled 2003 - 2007 and followed up through March 31 , 2013 . Over a median follow-up of 6.1 years ( interquartile range , 5.0 - 7.1 years ) , 515 participants survived expert-adjudicated incident stroke and 23,057 remained stroke  free . EXPOSURE Time-dependent incident stroke . MAIN OUTCOMES AND MEASURES The primary outcome was change in global cognition ( Six-Item Screener [ SIS ] , range , 0 - 6 ) . Secondary outcomes were change in new learning ( Consortium to Establish a Registry for Alzheimer Disease Word-List Learning ; range , 0 - 30 ) , verbal memory ( Word-List Delayed Recall ; range , 0 - 10 ) , and executive function ( Animal Fluency Test ; range , ≥0 ) , and cognitive impairment ( SIS score < 5 [ impaired ] vs ≥5 [ unimpaired ] ) . For all tests , higher scores indicate better performance . RESULTS Stroke was associated with acute decline in global cognition ( 0.10 points [ 95 % CI , 0.04 to 0.17 ] ) , new learning ( 1.80 points [ 95 % CI , 0.73 to 2.86 ] ) , and verbal memory ( 0.60 points [ 95 % CI , 0.13 to 1.07 ] ) . Participants with stroke , compared with those without stroke , demonstrated faster declines in global cognition ( 0.06 points per year faster [ 95 % CI , 0.03 to 0.08 ] ) and executive function ( 0.63 points per year faster [ 95 % CI , 0.12 to 1.15 ] ) , but not in new learning and verbal memory , compared with prestroke slopes . Among survivors , the difference in risk of cognitive impairment acutely after stroke , compared with immediately before stroke , was not statistically significant ( odds ratio , 1.32 [ 95 % CI , 0.95 to 1.83 ] ; P = .10 ) ; however , there was a significantly faster poststroke rate of incident cognitive impairment compared with the prestroke rate ( odds ratio , 1.23 per year [ 95 % CI , 1.10 to 1.38 ] ; P < .001 ) . For a 70-year-old black woman with average values for all covariates at baseline , stroke at year 3 was associated with greater incident cognitive impairment : absolute difference of 4.0 % ( 95 % CI , -1.2 % to 9.2 % ) at year 3 and 12.4 % ( 95 % CI , 7.7 % to 17.1 % ) at year 6 . CONCLUSIONS AND RELEVANCE Incident stroke was associated with an acute decline in cognitive function and also accelerated and persistent cognitive decline over 6 years
Background : Acupuncture has been using as an alternative non-pharmacological therapy in the management of post stroke depression and cognitive impairment but its effectiveness and safety remain controversial .
We conducted an overview of systematic review s with meta-analyses to evaluate the evidence on the effect of acupuncture in the treatment of stroke with conventional medicine intervention .