Pharmaceutical interventions for emotionalism after stroke.

Area of Science:

• Neurology
• Pharmacology
• Psychiatry

Background:

• Abnormal crying and laughing, known as emotionalism or pseudobulbar affect, can occur after stroke.
• Pharmaceutical interventions, particularly antidepressants, are being investigated for managing these emotional dysregulations.

Purpose of the Study:

• To evaluate the efficacy of pharmaceutical treatments in reducing emotional displays in post-stroke patients.
• To systematically review existing randomized controlled trials (RCTs) and quasi-RCTs on this topic.

Main Methods:

• Searched multiple databases including Cochrane Stroke, CENTRAL, MEDLINE, Embase, and PsycINFO up to May 2018.
• Included RCTs and quasi-RCTs comparing psychotropic medications to placebo in stroke patients with emotionalism.
• Analyzed data using risk ratios and mean differences, assessing heterogeneity and study quality with GRADE criteria.

Main Results:

• Seven trials with 239 participants were included (analysis based on five trials with 213 participants).
• Very low to moderate quality evidence suggests antidepressants may reduce emotionalism, with significant effects on reducing tearfulness (RR 2.18, 95% CI 1.29 to 3.71).
• No significant difference in mortality was found between antidepressant and placebo groups (RR 0.59, 95% CI 0.08 to 4.50).

Conclusions:

• Antidepressants show a potential benefit in reducing post-stroke emotionalism, but the evidence is of very low quality.
• Methodological limitations in current studies necessitate caution in interpretation and highlight the need for more rigorous research.
• Further high-quality trials are required to establish definitive conclusions on the effectiveness and safety of antidepressants for treating emotionalism after stroke.