Interventions for treating anxiety after stroke

Campbell Burton CA, Holmes J, Murray J, Gillespie D, Lightbody CE, Watkins CL, Knapp P

Published Online:

December 7, 2011

Anxiety after stroke occurs frequently and can be treated with antidepressants, other anxiety reducing drugs, or psychological therapy. This review of two trials, which included 175 participants, found that antidepressant and anxiety reducing drugs decreased the severity of anxiety symptoms. However, they also increased side effects. One trial showed that combining an antidepressant with psychotherapy also decreased anxiety symptom severity but not to a greater extent than antidepressant treatment alone. The findings are only applicable to stroke patients with both anxiety and depression as we did not find any studies that considered stroke patients with anxiety only. Future research will need to ensure that stroke patients with anxiety alone are also included in trials, and these trials should include a placebo control group.

Abstract (click to read)

Background:

Approximately 20% of stroke patients experience anxiety at some point after stroke.

Objectives:

To determine if any treatment for anxiety after stroke decreases the proportion of patients with anxiety disorders or symptoms, and to determine the effect of treatment on quality of life, disability, depression, social participation, risk of death or caregiver burden.

Search strategy:

We searched the trials register of the Cochrane Stroke Group (October 2010), CENTRAL (The Cochrane Library 2010, Issue 4), MEDLINE (1950 to October 2010), EMBASE (1947 to October 2010), PsycINFO (1806 to October 2010), Allied and Complementary Medicine database (AMED) (1985 to October 2010), Cumulative Index to Nursing and Allied Health (CINAHL) (1982 to October 2010), Proquest Digital Dissertations (1861 to October 2010), and Psychological Database for Brain Impairment Treatment Efficacy (PsycBITE) (2004 to October 2010). In an effort to identify further published, unpublished and ongoing trials, we searched trial registries and major international stroke conference proceedings, scanned reference lists, and contacted select individuals known to the review team who are actively involved in psychological aspects of stroke research, and the Association of the British Pharmaceutical Industry.

Selection criteria:

Two review authors independently screened and selected titles and abstracts for inclusion in the review. Randomised trials of any intervention in patients with stroke where the treatment of anxiety was an outcome were eligible.

Data collection and analysis:

Two review authors independently extracted data for analysis. We performed a narrative review. A meta-analysis was planned but not carried out as studies were not of sufficient quality to warrant doing so.

Main results:

We included two trials (three interventions) involving 175 participants with co-morbid anxiety and depression in the review. Both trials used the Hamilton Anxiety Scale (HAM-A) to assess anxiety, and neither included a placebo control group. 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 follow-up (P < 0.01). The second trial randomised 94 stroke patients, also with co-morbid anxiety and depression, to receive buspirone hydrochloride or standard care. At follow-up, the mean level of anxiety was significantly lower for those receiving buspirone relative to controls (P < 0.01). Half of the participants receiving paroxetine experienced adverse events that included nausea, vomiting or dizziness; however, only 14% of those receiving buspirone experienced nausea or palpitations. No information was provided about the duration of symptoms associated with adverse events.

Authors' conclusions:

There is insufficient evidence to guide the treatment of anxiety after stroke. The data available suggest that pharmaceutical therapy (paroxetine and buspirone) may be effective in reducing anxiety symptoms in stroke patients with co-morbid anxiety and depression. No information was available for stroke patients with anxiety only. Randomised placebo controlled trials are needed.

This record should be cited as:

Campbell Burton CA, Holmes J, Murray J, Gillespie D, Lightbody CE, Watkins CL, Knapp P. Interventions for treating anxiety after stroke. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD008860. DOI: 10.1002/14651858.CD008860.pub2

Assessed as up to date:

May 6, 2011

Find the research

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Primary Review Group:

Stroke Group

Health topics:

Heart & circulation > Stroke > Prevention & treatment of complications

Mental health > Anxiety disorders > Non-specific

Neurology > Stroke > Prevention & treatment of complications

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Interventions for treating anxiety after stroke

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