To evaluate the antidepressant effect of cognitive behavioral therapy (CBT) and other interventions on post-stroke depression.

A systematic research in PubMed, Embase, Cochrane Library, CNKI, and China Biomedical Literature Database was conducted. The search terms included "post-stroke depression", "cognitive behavioral therapy", "stroke/ /cerebral infarction", "depression" and "cognitive behavioral therapy/treatment", excluding non-clinical randomized controlled studies. The retrieval time limit was from the establishment of the database to December 2020. The statistical method was network meta-analysis, in which network plots and calibrated comparison funnel plots were drawn using the network group command of STATA14. Network relationship and intervention sequencing analysis were completed using the GEMTC package of R software.

A total of 27 clinical studies involving 2560 patients with post-stroke depression (PSD) were included. Compared with antidepressant treatment alone, CBT combined with antidepressant treatment (med-term efficacy: -4.43, 95%CI: -7.42 to -1.43; Long-term efficacy: Md=-4.33, 95%CI: -5.63~-3.06) and CBT combined with traditional Chinese medicine (TCM) (mid-term efficacy: Md=-9.48, 95%CI: -15.78~-3.20; Long-term efficacy: MD=-4.46, 95%CI :-7.43~-1.46) were significantly better. Compared with CBT alone, CBT combined with antidepressants (mid-term efficacy: -8.88, 95%CI :-16.43 to -1.30; Long-term efficacy: Md=-2.87, 95%CI :-4.90~-0.83) and CBT combined with traditional Chinese medicine (med-term efficacy: Md=-13.94, 95%CI :-23.54~-4.30; Long-term efficacy: MD=-2.99, 95%CI :-5.81~-0.11) were significantly better as well. The antidepressant effect of CBT, antidepressants, traditional Chinese medicine and acupuncture alone was superior to that of blank control, but the differences among them were not significant. The efficacy of different antidepressant interventions was ranked as follows: (1) Mid-term effects: CBT＋TCM＞CBT+antidepressants＞TCM＞antidepressants＞CBT; (2) Long-term effect: CBT＋traditional Chinese medicine, CBT＋antidepressants, CBT＋acupuncture>CBT＞acupuncture＞antidepressants＞No anti-depression treatment.

For PSD patients, cognitive behavioral therapy combined with antidepressants or traditional Chinese medicine was more effective than antidepressants alone.