Liang

Weak evidence that hyperbaric oxygen may be safe and effective for post-stroke depression.

Objectives:Post-stroke depression (PSD) is common consequence of stroke. However, today the majority of PSD patients remains untreated or inadequately treated, especially in the developing countries. Herein, we performed a meta-analysis to evaluate efficacy and safety of hyperbaric oxygen (HBOT) therapy for PSD.

Patients and methods:Seven electronic databases were comprehensively searched for randomized clinical trials (RCTs) from inception to May 2019. Outcome measures included response rate, depression severity, neurological deficit, physical disability and adverse events.

Results:A total of 27 RCTs involving 2250 participants were identified. Patients in HBOT group had a higher response rate than patients in control group (response rate: 69.4% vs 51.2%, odds ratio [OR]=2.51, 95% confidence interval [CI] [1.83–3.43], P =0.000).

HBO better for:  

Hamilton Depression (HAMD) –17 item scores (weighted mean difference [WMD] =−4.33, 95% CI [−4.82 to −3.84],          P=0.000)

HAMD-24 item scores (WMD=−4.31, 95% CI [−5.01 to −3.62], P=0.000)

National Institute of Health Stroke Scale (NIHSS) scores (WMD=−2.77, 95% CI [−3.57 to −1.98], P=0.000)

Chinese Stroke Scale (CSS) scores (WMD=−3.75, 95% CI [−5.12 to −2.38], P=0.000)

Modified Scandinavian Stroke Scale (MASSS) scores (WMD=−3.66, 95% CI [−6.26 to −1.06], P=0.000).

Barthel Index (WMD=10.68, 95% CI [7.98–13.37].

Patients with HBOT along with antidepressants treatment achieve superior results than patients with antidepressants monotherapy. Patients with HBOT monotherapy achieve a slightly higher response rate than patients with antidepressants monotherapy (OR=1.29, 95% CI [1.04–1.60], P=0.000). Besides, HBOT group reported less adverse events (9.6%vs16.6%, P < 0.05). The most frequent side-effect of HBOT is ear pain (26 cases).

Conclusion: Based on our pooled analysis, HBOT is effective and safe therapeutic approach for PSD. However, results should be cautiously interpreted due to a relatively poor methodological quality.

Comments:

1. MA dominated by Chinese studies unavailable to this reviewer to date. Only 1 of 27 included studies published in English and no studies from the Cochrane review are included. This may reflect the non-acute nature of interventions applied in the convalescent period rather than acute stroke.

2. Authors were only confident of randomisation in 8 of 27 studies and only 1 was blinded.Low quality RCTs likely

3. Conclusions are difficult to assess given the above. Some of the outcome measures apparently improved were assessing function (NIHSS) and QoL (Barthel Index).

Citation:Liang XX, Hao YG, Duan XM, Han XL, Cai XX. Hyperbaric oxygen therapy for post-stroke depression: A systematic review and meta-analysis. Clin Neurol Neurosurg. 2020 Aug;195:105910.

Reviewed by:Michael Bennett 22/07/2021

Update or delete by:July 2024