Deans' stroke musings: Efficacy and safety of Buyang Huanwu Decoction in the treatment of post-stroke depression: A systematic review and meta-analysis of 15 randomized controlled trials

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, November 10, 2022

Efficacy and safety of Buyang Huanwu Decoction in the treatment of post-stroke depression: A systematic review and meta-analysis of 15 randomized controlled trials

Why are you not solving the primary cause of depression? Lack of 100% recovery prortocols! Solve the primary problem and you don't need to work on secondary problems. DO YOU NOT UNDERSTAND?

Efficacy and safety of Buyang Huanwu Decoction in the treatment of post-stroke depression: A systematic review and meta-analysis of 15 randomized controlled trials

Kun Zhen¹^†,

Hongshuo Shi¹^†,

Xuecheng Zhang^2,3^†,

Xiangyi Liu¹,

Wenwen Li¹,

Guomin Si⁴,

Hongling Jia⁵^* and

Dong Guo⁶^*

¹College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
²Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
³The First Clinical Medical College, Beijing University of Chinese Medicine, Beijing, China
⁴Department of Traditional Chinese Medicine, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
⁵The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
⁶The First Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China

Background: Post-stroke depression is the most common neuropsychiatric disorder after stroke, which seriously affects patients' post-stroke recovery and quality of life, and is prone to recurrence of stroke and death. Buyang Huanwu Decoction is effective in treating post-stroke depression, but there is a lack of scientific systematic review and meta-analysis.

Objective: To evaluate the efficacy and safety of Buyang Huanwu Decoction in treating post-stroke depression.

Methods: A total of eight databases were searched by two investigators from Embase, PubMed, The Cochrane Library, Web of Science, Wanfang, CNKI, VIP, and CBM to collect randomized controlled trials that applied BHD to PSD from the time of database construction to May 2022. Data analysis was performed using Review mange5.4.

Results: A total of 15 studies with 1,242 patients were included. Meta-analysis showed that compared with the antidepressant drug control group, the change value of the HAMD scale in the Buyang Huanwu Decoction group was significantly lower [p < 0.00001, SMD = −0.85, 95% CI (−1.10, −0.61)]; after subgroup analysis, the effect of BHD for 4 weeks was the most significant; the total clinical effective rate was significantly increased [p = 0.001, RR = 1.33, 95% CI (1.12, 1.57)]; neurological deficit score [p = 0.002, SMD = −1.03, 95% CI (−1.67, −0.39)], the incidence of adverse reactions [p = 0.02, RR = 0.42, 95% CI (0.20, 0.89)], and adverse reaction scale scores [p < 0.00001, MD = −3.58, 95%CI (−4.09, −3.08)] were significantly lower.

Conclusion: Compared with antidepressants, the Buyang Huanwu Decoction is more effective and safer in the treatment of post-stroke depression patients. However, more high-quality studies are needed to further support the above conclusion.

Introduction

Stroke is one of the leading causes of death and disability in the world, although the mortality and burden of stroke vary considerably across countries (1). Among them, post-stroke depression (PSD) is the most common stroke neuropsychiatric sequelae, and the prevalence of PSD is 11–41% since 2019 (2), and the cumulative incidence of depression was 52% 5 years after stroke (3). PSD is the main factor of poor recovery, poor quality of life, and poor rehabilitation after stroke (4). At the same time, the probability of stroke recurrence and death in PSD patients is higher than that in non-PSD patients (5, 6). In contrast, early treatment of PSD can enhance the recovery of physical function and cognition after stroke, and increase the survival rate of patients 10 years after stroke (7).

Currently, PSD is severely under-diagnosed and under-treated and is best treated with a combination of pharmacological, psychosocial, and stroke-focused treatment, which includes restoration of limb function and psycho-cognition, and prevention of new acute vascular events (8). A wide range of antidepressants is commonly used in clinical practice, such as selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and serotonin-norepinephrine reuptake inhibitors (SNRIs), which allow depressive symptoms to be significantly improved (9–11). Studies have shown that the use of SSRIs in the early stages of stroke not only reduces the incidence of PSD but also promotes neuronal regeneration and plasticity changes, which facilitate the recovery of nerve function, cognitive and language functions, and improve the prognosis of patients after stroke (12, 13). However, compared with a placebo, SSRIs were only significantly effective for mild depression and did not improve motor and cognitive function or quality of life in patients with PSD, nor did they significantly improve moderate to severe depression (14). Simultaneously, long-term use of antidepressants is likely to cause gastrointestinal dysfunction and increase the risk of cerebrovascular events (15).

In recent years, Chinese herbal medicine as a complementary or alternative therapy has been introduced to treat PSD, and studies have reported excellent antidepressant efficacy and a reduced incidence of adverse effects (16–19). Buyang Huanwu Decoction (BHD) is a classic Chinese medicine prescription for treating stroke and its sequelae. Experimental studies have confirmed that BHD can improve nerve injury, reduce nerve apoptosis, reduce oxidative stress injury, induce cell regeneration, and so on (20–23). At present, BHD alone or in combination with conventional antidepressants has been widely used in the treatment of post-stroke depression in China (24–38). However, there is still a lack of reliable systematic review and meta-analysis of BHD therapy for PSD. The purpose of this study is to comprehensively investigate the efficacy and safety of BHD in the treatment of PSD, which is as follows: (1) To determine whether BHD is effective compared with conventional antidepressants; and (2) to compare the incidence of adverse reactions of BHD and determine the safety of BHD in treating PSD.