Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. May 19, 2023; 13(5): 226-233
Published online May 19, 2023. doi: 10.5498/wjp.v13.i5.226
Effect of hyperbaric oxygen on post-stroke depression
Hong Guo, Yi-Ran Ge, Yan-Bin Dong, Xiao-Chuan Zhao, Guan-Li Su, Jin-Cheng Wang
Hong Guo, Yan-Bin Dong, Department of Psychology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
Yi-Ran Ge, Department of Clinical Psychology, The First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
Xiao-Chuan Zhao, Guan-Li Su, Jin-Cheng Wang, Department of Psychiatry, The First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
Author contributions: Guo H and Ge YR concepted the study; Guo H, Dong YB and Zhao XC collected the data; Guo H, Zhao XC, Wang JC and Ge YR contributed to the formal analysis; Guo H and Zhao XC contributed to the investigation; Guo H, Zhao XC and Su GL contributed to the methodology; Guo H, Zhao XC, Su GL and Dong YB supervised the study; Zhao XC validated the study; Guo H and Ge YR contributed to the visualization of the study; Guo H and Wang JC originally drafted the manuscript; Guo H, Ge YR, Wang JC and Dong YB reviewed and edited the manuscript.
Institutional review board statement: The study was reviewed and approved by The First Medical Center, Chinese PLA General Hospital Institutional Review Board (Approval No. 20180068).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: We declare that there are no conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin-Cheng Wang, PhD, Chief Doctor, Department of Psychiatry, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang 050000, Hebei Province, China. 757451886@qq.com
Received: March 8, 2023
Peer-review started: March 8, 2023
First decision: March 28, 2023
Revised: April 8, 2023
Accepted: April 12, 2023
Article in press: April 12, 2023
Published online: May 19, 2023
Processing time: 72 Days and 7.2 Hours
Abstract
BACKGROUND

In patients with post-stroke depression (PSD) in diabetes, the situation may be more complex, requiring simultaneous treatment of blood glucose, depressive symptoms, and neurological dysfunction. Hyperbaric oxygen (HBO) therapy can improve tissue oxygen content and improve the situation of ischemia and hypoxia, thus playing a role in protecting brain cells and restoring the function of brain cells. However, there are few studies on HBO therapy for patients with PSD. This study explores the clinical efficacy of such therapy for stroke complicated with depression and diabetes mellitus, and to provide reference and basis for clinical treatment and development through the application of relevant rating scales and laboratory test indicators.

AIM

To evaluate the clinical effects of HBO therapy on patients with diabetes with PSD.

METHODS

A total of 190 diabetic patients with PSD were randomly divided into observation and control groups (95 patients per group). The control group received escitalopram oxalate 10mg once a day for eight weeks. In addition, the ob-servation group was also given HBO therapy, once a day, five times a week, for eight weeks. The Montgomery Depression Rating Scale (MADRS), National Institutes of Health Stroke Scale (NIHSS), hypersensitive C-reactive protein, tumor necrosis factor (TNF)-α, and fasting glucose levels were compared.

RESULTS

There were no significant differences in age, sex, or depression course between the groups (P > 0.05). After HBO treatment, MADRS scores in both groups decreased significantly (14.3 ± 5.2), and were significantly lower in the control group (18.1 ± 3.5). After HBO treatment, NIHSS scores in both groups decreased significantly, and scores in the observation group (12.2 ± 4.0) decreased more than in the control group (16.1 ± 3.4), the difference was statistically significant (P < 0.001). The levels of hypersensitive C-reactive protein and TNF-α in both groups were significantly decreased, and the observation group was significantly lower than the control group (P < 0.001). Fasting blood glucose levels in both groups decreased significantly, and those in the observation group decreased more (8.02 ± 1.10) than in the control group (9.26 ± 1.04), with statistical significance (t = -7.994, P < 0.001).

CONCLUSION

HBO therapy can significantly improve depressive symptoms and neurological dysfunction in patients with PSD, and reduce the levels of hypersensitive C-reactive protein, TNF-α and fasting blood glucose.

Keywords: Hyperbaric oxygen therapy; Post-stroke depression; Diabetes; Hypersensitive C-reactive protein; Tumor necrosis factor-α; Fasting plasma glucose

Core Tip: Post stroke depression is one of the common complications of stroke patients. It affects stroke patients in the acute phase and also occurs in the rehabilitation phase, with an incidence rate of about 33%. However, many patients with post-stroke depression may still not be diagnosed and treated. It is currently believed that biological and psychological factors are involved in the occurrence and development of post-stroke depression. Risk factors of post-stroke depression include gender, psychiatric history, size and location of stroke, poor social support and degree of physical injury. Post-stroke depression may not only affect the emotional state and quality of life of patients, but also hinder the recovery of neurological function, and even increase the mortality of patients. Studies have shown that changes in ischemic hypoxia and brain cell damage are common mechanisms of stroke and post-stroke depression, so improving ischemic hypoxia may be an effective treatment. Diabetes is a chronic disease characterized by elevated blood sugar and other metabolic disorders. diabetes is associated with an increased risk of stroke and post-stroke depression.