Effectiveness of non-pharmacological interventions for treating post-stroke depressive symptoms: Systematic review and meta-analysis of randomized controlled trials.
Yejin Lee, Brian Chen, Mandy W M Fong and 6 others
PMID 32783504WHAT IT FOUND
Non-drug therapies slightly reduced post-stroke depression overall.
Music therapy and psychosocial therapy showed small-to-medium benefits, while exercise and multifactorial interventions did not. These effects were small, so these therapies should complement, not replace, standard care.
Key findings
01Overall, non-pharmacological interventions had a small but significant effect on reducing depressive symptoms immediately after treatment and at follow-up.
02Music therapy showed a medium effect size, while acupuncture, exercise, and multifactorial therapy did not show statistically significant benefits.
03Psychosocial therapy showed a small significant effect at post-intervention, but this benefit was not sustained at follow-up.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
Most included trials excluded patients with aphasia, significant cognitive impairment, or other neurological conditions, so results may not apply to the most complex patients seen in clinical practice. The overall effect sizes were small, meaning the clinical impact on an individual patient may be modest. Benefits for specific therapies like psychosocial interventions were not sustained at follow-up, and only 13 of the initial 22 trials had enough data to be included in the final analysis. Heterogeneity in intervention types (e.g., different forms of 'exercise' or 'psychosocial therapy') makes it difficult to prescribe a specific protocol.
Declared interests
The authors declare no conflicts of interest. The study was not funded by a commercial sponsor.
The easy way to misread this
Do not interpret the significant overall effect as evidence that any single non-drug therapy is a powerful standalone treatment for depression. The effect sizes were small, and for some categories like exercise, the results were not statistically significant. These therapies are best viewed as supportive additions to standard care, not replacements for medication or intensive psychological treatment when indicated.