Clinical Study Of Transcranial Direct Current Stimulation Combined With Sertraline On Post-stroke Depression

Objective To observe the efficacy of transcranial direct current stimulation（t DCS）combined with sertraline in the treatment of post-stroke depression（PSD）patients,and its effects on anxiety,cognition and activities of daily living（ADL）.Then,follow up the patients after treatment to evaluate the duration of the effect after t DCS treatment.Methods 40 patients with post-stroke depression were randomly divided into experimental group and control group,20 patients in each group.Patients in both groups were treated with the similar rehabilitation therapy and sertraline 50 mg/d.On this basis,the experimental group was treated with t DCS,while the control group was treated with sham transcranial direct current stimulation,in which the anode was placed in the left dorsolateral prefrontal cortex and the cathode in the right dorsolateral prefrontal cortex.Treatment for 4 weeks and followed up for 4 weeks.The scales were assessed at baseline,after 2 weeks treatment,after 4 weeks treatment,2 weeks and 4 weeks after treatment.Hamilton Depression Scale（HAMD）,Hamilton Anxiety Rating Scale（HAMA）,mini mental state examination（MMSE）and modified Barthel index（MBI）were used to assess depression,anxiety,ADL.Two-way repeated measures anova was used to compare the scores of each scale in two groups.Analyze the HAMD’s five subitem comparing with two independent sample Wilcoxon rank sum test.Statistically significant difference in taking the level of P 0.05.Graphpad prism 8.02 software was used for drawing.Results There were no significant differences in the scores of HAMD,HAMA,MMSE and MBI before treatment,as well as sex,age,education,stroke course,stroke type,and stroke hemisphere（P>0.05）.After two-way repeated measures anova,time effect,group effect and time*group effect had significant influence on HAMD score(F_time=11.144,F_group=561.492,F_time*group=40.85,P<0.05).It is suggested that the HAMD scores of patients with different interventions are different,and the HAMD scores of the two groups change with time.Compared with baseline,HAMD scores of the two groups decreased significantly during treatment and follow-up（P<0.05）.There were significant differences in the HAMD scores between the two groups at the time of treatment and follow-up（P<0.05）.During the treatment and follow-up period,the decrease of HAMD score in the experimental group decreased more than that in the control group.There was no significant difference in HAMD’s five subitem between the two groups before treatment（P>0.05）.Anxiety/somatization factor showed significant difference between groups after 2 weeks treatment（P<0.05）.Two weeks after treatment,the two groups began to differ significantly in cognitive impairment and sleep disturbance factor（P<0.05）.After 4 weeks treatment,significant differences in the levels of retardation factor were observed（P<0.05）.Weight factor showed no significant difference between the treatment and follow-up period（P>0.05）.The time effect and time*group effect had statistical significance on HAMA score(F_time=140.643,F_time*group=21.296,P<0.05),and the group effect(F_group=3.915,P=0.055>0.05)had no statistical significance on HAMA score.Further analysis of single effects,there was a significant difference in HAMA scores between the experimental and control groups after 4 weeks treatment（P<0.05）.After 4 weeks treatment,the HAMA scores of the experimental group were lower than those of the control group,the experimental group could maintain its advantage during follow-up.The time effect,group effect and time*group effect on MMSE score were statistically significant(F_time=99.736,F_group=4.358,F_time*group=19.429,p<0.05).Compared with before treatment,MMSE scores in the experimental group began to increase significantly after 2 weeks of treatment（P<0.05）,while those in the control group began to increase significantly after 4 weeks of treatment（P<0.05）,suggesting that the improvement of cognition in the experimental group was earlier than that in the control group.There was no significant difference in MMSE score between the two groups at 2weeks of treatment（P>0.05）.There was significant difference in MMSE score between the two groups at 4 weeks of treatment and during the follow-up period（P<0.05）.The MMSE score of the experimental group was significantly higher than that of the control group after 4 weeks of treatment.During the follow-up period,the MMSE score of the experimental group increased slowly,but still maintained the advantage effect obtained during the treatment.The time effect and time*group effect had significant effect on MBI score(F_time=109.48,F_time*group=3.756,P<0.05),while the intergroup effect(F_group=0.141,P>0.05)had no significant effect.Compared with the baseline,MBI scores of the two groups were significantly different during treatment and follow-up（P<0.05）.Furthermore,there was no significant difference in MBI score between the two groups at each time point（P>0.05）.These results suggest that compared with the control group,t DCS combined with sertraline cannot significantly improve the activities of daily living of PSD patients.Conclusion TDCS combined with sertraline can effectively reduce the depression of PSD patients,improve the anxiety and cognitive function of PSD patients,but has no significant effect on their activities of daily living.After stopping t DCS stimulation,the improvement of depression,anxiety and cognitive function of PSD patients can still maintain for 4 weeks.