Efficacy and influencing factors of 3-N-Butylphthalide-trazodone combination in managing post-ischemic stroke depression

doi:10.5498/wjp.116579

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Publication Name

World Journal of Psychiatry

ISSN

2220-3206

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Psychiatry. Sep 19, 2026; 16(9): 116579
Published online Sep 19, 2026. doi: 10.5498/wjp.116579

Efficacy and influencing factors of 3-N-Butylphthalide-trazodone combination in managing post-ischemic stroke depression

Zhi-Hua Zhu, Yong-Sen Lin, Zhu-Quan Hong

Zhi-Hua Zhu, Yong-Sen Lin, Zhu-Quan Hong, Department of Neurology, Quanzhou First Hospital, Quanzhou 362000, Fujian Province, China

Author contributions: Zhu ZH designed the research and wrote the first manuscript; Zhu ZH and Lin YS contributed to conceiving the research and analyzing data; Zhu ZH and Hong ZQ conducted the analysis and provided guidance for the research; all authors reviewed and approved the final manuscript.

Institutional review board statement: The study was reviewed and approved by the Medical Ethics Committee of Quanzhou First Hospital, No. [2026]K133.

Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.

Conflict-of-interest statement: There is no conflict of interest.

Data sharing statement: No additional data are available.

Corresponding author: Zhu-Quan Hong, Associate Chief Physician, Department of Neurology, Quanzhou First Hospital, No. 1028 Anji South Road, Fengze District, Quanzhou 362000, Fujian Province, China. 971696252@qq.com

Received: January 30, 2026
Revised: March 12, 2026
Accepted: May 8, 2026
Published online: September 19, 2026
Processing time: 205 Days and 22.3 Hours

Abstract

BACKGROUND

Given the current insufficiency of effective prevention and treatment methods for post-ischemic stroke depression (PISD), the exploration of improved management strategies is essential.

AIM

To analyze the efficacy and influencing factors of the 3-N-Butylphthalide (NBP)-Trazodone (TRZ) combination in the management of PISD.

METHODS

A total of 122 patients with PISD (March 2023-March 2025) were enrolled. According to the treatment regimens they actually received, 56 cases receiving TRZ alone were assigned to the reference group, while 66 cases administered NBP + TRZ were allocated to the research group. The following parameters were comparatively analyzed: Therapeutic efficacy; safety (nausea, celialgia, headache, and drowsiness); National Institutes of Health Stroke Scale (NIHSS); Barthel Index; 17-item Hamilton Depression Rating Scale; and serum neurotransmitters [5-hydroxytryptamine (5-HT), dopamine (DA), and norepinephrine (NE)]. Subsequently, determinants of treatment efficacy were explored using uni- and multivariate analyses.

RESULTS

Compared with the reference group, the research group demonstrated: (1) A markedly higher overall treatment effectiveness rate; (2) A comparable total incidence of adverse reactions; (3) Significantly reduced NIHSS and HAMD-17 scores after intervention; and (4) Improved Barthel Index and higher 5-HT, DA, and NE levels after treatment. Comorbid hyperlipidemia, 5-HT, DA, and medication regimen were identified as independent determinants of treatment efficacy in patients with PISD.

CONCLUSION

The NBP-TRZ combination is effective in the management of PISD. Ineffective treatment is associated with clinical features such as hyperlipidemia, 5-HT < 60 ng/mL, DA < 122 ng/mL, and TRZ monotherapy.

Keywords: 3-N-Butylphthalide; Trazodone; Post-ischemic stroke depression; Therapeutic effectiveness; Influencing factors

Core Tip: For the optimization of treatment for post-ischemic stroke depression, this study verified the efficacy of the 3-N-Butylphthalide (NBP)-Trazodone (TRZ) combination and explored efficacy-associated determinants. Without increasing the total incidence of adverse reactions, the NBP-TRZ combination was significantly superior to TRZ monotherapy in therapeutic efficacy, while also significantly improving patients’ neurological function and daily living ability, alleviating depression, and regulating serum neurotransmitters. Comorbid hyperlipidemia, low 5-hydroxytryptamine, reduced dopamine, and TRZ monotherapy were associated with treatment ineffectiveness in such patients.