ObjectiveTo systematically review the efficacy of different stimulation modalities of repetitive transcranial magnetic stimulation (rTMS) combined with SSRI in improving depressed mood after stroke using network meta-analysis. MethodsThe PubMed, EMbase, Cochrane Library, Web of Science, CNKI, VIP, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) related to the objectives from inception to October 1, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Network meta-analysis was then performed by using R 4.2.1software. ResultsA total of 25 RCTs involving 2 152 patients were included. Four types of rTMS stimulation combined with SSRIs were included: high-frequency stimulation of the left dorsolateral prefrontal (l-DLPFC), low-frequency stimulation of l-DLPFC, low-frequency stimulation of the right dorsolateral prefrontal (r-DLPFC), and low-frequency stimulation of the bilateral DLPFC. The results of the network meta-analysis showed that the effect of combining four stimulation methods with SSRI in treating depression was better than that of SSRI alone (P<0.05). Probability sorting results showed that low-frequency stimulated bilateral DLPFC (88.9%) > low-frequency stimulated l-DLPFC (63.1%) > high-frequency stimulation l-DLPFC (57.1%) > low-frequency stimulation r-DLPFC (40.4%). There was no statistically significant difference in the incidence of adverse reactions between the four stimulation methods combined with SSRI and the use of SSRI alone (P>0.05). Conclusion?rTMS combined with SSRIs is better than SSRIs alone in improving depressed mood after stroke. Low-frequency rTMS stimulation of bilateral DLPFC may be the best. Meanwhile, the safety of different stimulation methods is good.
ObjectiveTo systematically review the antidepressant efficacy of selective serotonin re-uptake inhibitors (SSRIs) and their effect on inflammatory factors in adults with major depressive disorder (MDD). MethodsElectronic searches were conducted in PubMed, Embase, Web of Science Core Collection, ProQuest, JSTOR, PsycINFO, The Cochrane Library, Epistemonikos, China National Knowledge Infrastructure (CNKI), and Chinese Biomedical Literature Database (CBM) from database inception to December 31, 2024. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was performed using R 4.4.2 software. ResultsA total of 62 controlled studies (including 63 reports) was included, consisting of 36 randomized controlled trials (RCTs), 4 non-randomized controlled trials (NRCTs), and 23 case-control studies. Meta-analysis showed that the overall antidepressant effect size of SSRIs was SMD ?3.18, 95%CI ?3.56 to ?2.80, with no statistically significant difference in efficacy between different SSRIs (Q=6.77, P=0.24). However, their antidepressant efficacy was influenced by the country of origin of the study participants and the duration of intervention. SSRIs exerted significant inhibitory effects on 17 pro-inflammatory factors, but with high heterogeneity. SSRIs had no significant overall effect on anti-inflammatory factors (SMD 0.81, 95%CI ?0.20 to 1.82). However, subgroup analysis revealed that escitalopram exerted significant promoting effects on IL-10 (SMD 1.11, 95%CI 0.61 to1.60) and IL-13 (SMD 2.40, 95%CI 1.84 to 2.95). ConclusionSSRIs are effective antidepressants but vary in their effects on inflammatory factors. Among them, escitalopram has a potential bidirectional regulatory effect on inflammatory factors, and more high-quality multicenter studies are needed in the future for verification..