ABSTRACT
Objective To explore the effects of sertraline combined with attribution retraining in post-stroke depression and recovery of neurological function.Methods A total of seventy-eight patients with post-stroke depression were randomly divided into research group and control group.The research group was treated by sertraline combined with attribution retraining and the control group was treated by sertraline only for 8 weeks.Depressive symptoms were assessed using the Hamilton Depression Rating Scale (HAMD) and recovery of neurological functions using the National Institute of Health Stroke Scale (NIHSS) at baseline and at the end of the 24,44,64 and 84 week.Results Repeated measure ANOVA for the total scores of HAMD showed that the main effect of time,the main effect of group and the interactive effect of time and group were significant (P＜0.05).Total scores of HAMD in the research group were significantly lower than those in the control group at the end of the 2nd,44,64 and 84 week [(18.25±4.27) vs.(20.81±4.63),(15.94±3.47)vs.(18.12±4.51),(12.85±3.12) vs.(16.54±3.70),(10.42±3.66) vs.(13.09±3.59),P＜0.05].HAMD Total scores in two groups were showed significantly decreased on each time point after treatment (P＜0.01).Effective rates (using reduction rate of HAMD total scores as evaluation) were more significant in the research group than those in the control group at the end of the 8th week (77.5％ vs.52.6％,P＜0.05).The repeated measure ANOVA showed that the main effect of time in NIHSS total scores was significant (P＜0.01).The main effect of group and the interactive effect of time and group in NIHSS total scores were not significant (P＞0.05).Total scores of NIHSS in two groups significantly decreased on each time point after treatment (P＜0.01).Conclusions Sertraline combined with attribution retraining can significantly relieve post-stroke depression and attribution training does not have obvious effects on the recovery of neurological function.
ABSTRACT
The aim of this study was to compare the effectiveness of attribution retraining group therapy (ARGT) with selective serotonin reuptake inhibitors (SSRIs) in the treatment of major depressive disorder (MDD), generalized anxiety disorder (GAD), and obsessive-compulsive disorder (OCD). Subjects were sequentially recruited and randomized into two groups, one receiving ARGT (n = 63) and the other SSRIs (n = 66) for 8 weeks. Fifty-four ARGT outpatients with MDD (n = 19), GAD (n = 19), and OCD (n = 16) and 55 SSRI outpatients with MDD (n = 19), GAD (n = 19), and OCD (n = 17) completed the study. All subjects were assessed using the Hamilton Depression Scale and Hamilton Anxiety Scale before and after treatment. The 10-item Yale-Brown Obsessive Compulsive Scale was employed only for OCD subjects. Plasma levels of serotonin, norepinephrine, cortisol, and adrenocorticotropic hormone were also measured at baseline and 8 weeks after completion of treatment. Symptom scores were significantly reduced (P < 0.001) in both the ARGT and SSRI groups at the end of treatment. However, MDD, GAD and OCD patients in the ARGT group had significantly lower plasma cortisol concentrations compared to baseline (P < 0.05), whereas MDD and OCD patients receiving SSRIs showed significantly increased plasma levels of serotonin (P < 0.05). These findings suggest that ARGT may modulate plasma cortisol levels and affect the hypothalamus-pituitary-adrenal axis as opposed to SSRIs, which may up-regulate plasma serotonin levels via a different pathway to produce an overall improvement in the clinical condition of the patients.