Interventions for Treating Anxiety after Stroke

Summary

A Cochrane review [Abstract] 1 included 3 trials with 196 participants. They were stroke patients with co-morbid anxiety and depression, no information was available for stroke patients with anxiety only. For the first 2 studies, no information was provided about the setting from which participants were recruited (e.g. hospital, or community based), and the length of time after stroke at time of recruitment was not specified. Also, neither study described what was involved as a routine care in the control groups.

• One trial randomised 81 patients to paroxetine, paroxetine plus psychotherapy or standard care. Mean level of anxiety severity scores were 58% and 71% lower in the paroxetine, and paroxetine plus psychotherapy groups, respectively, compared with those in standard care at a follow-up time of 6 weeks (p<0.01). Half of the participants receiving paroxetine experienced adverse events that included nausea, vomiting or dizziness.
• The second trial randomised 94 stroke patients with co-morbid anxiety and depression to receive buspirone or standard care. At follow-up of 4 weeks, the mean level of anxiety was significantly lower for those receiving buspirone relative to controls (p<0.01). Only 14% of those receiving buspirone experienced nausea or palpitations. No information was provided about the duration of symptoms associated with adverse events.
• The third trial (n=19) randomised community-dwelling stroke survivors to 4-week use of a relaxation CD or to wait list control. This trial assessed anxiety using the Hospital Anxiety and Depression Scale and reported a reduction in anxiety at 3 months among patients who had used the relaxation CD (mean SD 6.9 (± 4.9) and 11.0 (± 3.9), p = 0.001).

Comment: The quality of the evidence is downgraded by study quality (inadequate allocation concealment, lack of blinding), imprecise results (limited study size for each comparison) and indirectness of evidence (differences in studied patients, short follow-up time).

References

• Knapp P, Campbell Burton CA, Holmes J et al. Interventions for treating anxiety after stroke. Cochrane Database Syst Rev 2017;5():CD008860. [PubMed]