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Pharmaceutical interventions for emotionalism after stroke.

Sabine Allida1, Allan House2, Maree L Hackett1

  • 1Mental Health Program, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.

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Summary

Antidepressants may help reduce crying and laughing episodes after a stroke. However, evidence is limited, and more research is needed to confirm the benefits and safety of these treatments.

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Area of Science:

  • Neurology
  • Pharmacology
  • Clinical Trials

Background:

  • Post-stroke emotionalism, characterized by abnormal crying or laughing, affects patient quality of life.
  • Antidepressants are being investigated as a potential treatment for this condition.

Purpose of the Study:

  • To evaluate the efficacy and safety of pharmaceutical interventions for emotionalism following stroke.
  • To synthesize evidence from randomized controlled trials (RCTs) and quasi-RCTs.

Main Methods:

  • Searched multiple databases including Cochrane Stroke Group Register, CENTRAL, MEDLINE, and Embase up to May 2022.
  • Included RCTs and quasi-RCTs comparing psychotropic medications to placebo in stroke patients with emotionalism.
  • Assessed risk of bias and used GRADE methodology to determine evidence certainty.

Main Results:

  • Seven trials with 239 participants were included; analysis focused on five trials (213 participants).
  • Antidepressants likely reduce tearfulness (moderate-certainty evidence) but evidence for reducing emotionalism frequency/severity is very low.
  • Limited data on adverse events; no significant difference in mortality between antidepressants and placebo.

Conclusions:

  • Antidepressants may offer a benefit in managing post-stroke emotionalism, particularly reducing tearfulness.
  • Conclusions are limited by small trial sizes, potential bias, and very low-certainty evidence for some outcomes.
  • Further high-quality research with standardized outcome measures and adverse event reporting is crucial.