|
|
音乐治疗在脑卒中后抑郁康复中的应用
|
Abstract:
脑卒中后抑郁(Post-Stroke Depression, PSD)是卒中后最常见的神经精神并发症之一，音乐治疗作为一种安全、非侵入性的疗法，是治疗情绪障碍和其他获得性脑损伤患者的有效方法。本研究通过回顾国内外相关研究，从神经可塑性与神经再生机制、情绪调节与神经递质通路、炎症与生物能量代谢调节以及认知–情绪整合与心理社会支持四个方面阐明了音乐干预脑卒中后抑郁的潜在机制；梳理了主要音乐模式干预脑卒中后抑郁的现状；并讨论了个性化音乐治疗、主动参与式音乐治疗、五行音乐治疗等不同音乐干预模式在脑卒中后抑郁康复治疗中的优势与局限所在。最后进行展望，音乐治疗在脑卒中后抑郁康复中展现出独特优势，未来研究可开展多中心大样本随机对照试验，结合功能磁共振(FMRI)等神经影像技术，动态追踪音乐干预对神经环路的重塑过程，为音乐干预的临床应用提供理论依据。
Post-Stroke Depression (PSD) is one of the most common neuropsychiatric complications after stroke. Music therapy, as a safe and non-invasive approach, is an effective method for treating mood disorders and other acquired brain injury patients. Our study reviewed relevant domestic and international research to clarify the potential mechanisms of music intervention in PSD from four aspects: neural plasticity and neuroregeneration mechanisms, emotion regulation and neurotransmitter pathways, inflammation and bioenergy metabolism regulation, and cognitive-emotional integration and psychosocial support. We also summarized the current status of major music modes in the intervention of PSD and discussed the advantages and limitations of different music intervention models, such as Personalized Music Therapy, active participation music therapy, and Five-Element music therapy in the rehabilitation treatment of PSD. Finally, we suggest that music therapy shows unique advantages in the rehabilitation of PSD. Future research can conduct multi-center large-sample randomized controlled trials and combine neuroimaging techniques, such as functional magnetic resonance imaging (FMRI) to dynamically track the remodeling process of neural circuits by music intervention, providing a theoretical basis for the clinical application of music intervention.
| [1] | 高睿泽, 韩名媛, 吕晓琳, 孙忠人, 杨成妍, 王羽心, 尹洪娜(2025). 针刺治疗卒中后抑郁临床研究进展. 中国中医药信息杂志, 32(3), 186-191. |
| [2] | 黄海鹏, 于斌, 管其凡, 徐开阳, 钟祯, 马诗棋, 王洪峰(2022). 针刺治疗脑卒中后抑郁的临床研究进展. 中国老年学杂志, 42(18), 4617-4621. |
| [3] | 靳胜燕(2024). 常规心理干预联合五行音乐调神法治疗脑卒中后抑郁的效果. 临床医学, 44(6), 68-70. |
| [4] | 林法财, 黄德弘, 秦宇航, 顾一煌, 吴云川(2017). 五行音乐治疗脑卒中后抑郁患者的有效性及安全性研究. 中国康复医学杂志, 32(12), 1390-1393. |
| [5] | 刘银花(2024). 脑卒中后抑郁心理干预措施研究进展. 心理月刊, 19(22), 235-240. |
| [6] | 齐国豪(2017). 针灸联合体感音乐治疗对脑卒中后抑郁患者康复的影响. 中医临床研究, 9(20), 70-72. |
| [7] | 夏五妹, 付芳娜, 吴慧群, 陈逸群, 吴克琴, 付倩雨, 胡杰(2024). 正角调正宫调音乐干预在老年脑卒中后抑郁患者中的应用效果研究. 当代护士(上旬刊), 31(5), 27-30. |
| [8] | 袁斌, 吴云川(2021). 针刺结合五音疗法对脑卒中后抑郁模型大鼠神经行为及不同脑区5-HT、NE含量的影响. 时珍国医国药, 32(8), 2025-2028. |
| [9] | 岳红霞(2015). 针灸联合体感音乐治疗对脑卒中后抑郁患者康复的影响. 吉林中医药, 35(2), 203-205. |
| [10] | 章秋燕, 江灵珊, 邱红虹(2024). 五行音乐之“角调”结合运动性引导想象训练改善脑卒中后抑郁患者睡眠的影响. 世界睡眠医学杂志, 11(8), 1794-1796, 1800. |
| [11] | Axelsen, J. L., Meline, J. S. J., Staiano, W., & Kirk, U. (2022). Mindfulness and Music Interventions in the Workplace: Assessment of Sustained Attention and Working Memory Using a Crowdsourcing Approach. BMC Psychology, 10, Article No. 108. https://doi.org/10.1186/s40359-022-00810-y |
| [12] | Baylan, S., Haig, C., MacDonald, M., Stiles, C., Easto, J., Thomson, M. et al. (2020). Measuring the Effects of Listening for Leisure on Outcome after Stroke (MELLO): A Pilot Randomized Controlled Trial of Mindful Music Listening. International Journal of Stroke, 15, 149-158. https://doi.org/10.1177/1747493019841250 |
| [13] | Baylan, S., Swann-Price, R., Peryer, G., & Quinn, T. (2016). The Effects of Music Listening Interventions on Cognition and Mood Post-Stroke: A Systematic Review. Expert Review of Neurotherapeutics, 16, 1241-1249. https://doi.org/10.1080/14737175.2016.1227241 |
| [14] | Bhandarkar, S., Salvi, B. V., & Shende, P. (2024). Current Scenario and Potential of Music Therapy in the Management of Diseases. Behavioural Brain Research, 458, Article ID: 114750. https://doi.org/10.1016/j.bbr.2023.114750 |
| [15] | Castilla-Guerra, L., Fernandez Moreno, M. D. C., Esparrago-Llorca, G., & Colmenero-Camacho, M. A. (2020). Pharmacological Management of Post-Stroke Depression. Expert Review of Neurotherapeutics, 20, 157-166. https://doi.org/10.1080/14737175.2020.1707666 |
| [16] | Das, J., & G.K., R. (2018). Post Stroke Depression: The Sequelae of Cerebral Stroke. Neuroscience & Biobehavioral Reviews, 90, 104-114. https://doi.org/10.1016/j.neubiorev.2018.04.005 |
| [17] | Espárrago Llorca, G., Castilla-Guerra, L., Fernández Moreno, M. C., Ruiz Doblado, S., & Jiménez Hernández, M. D. (2015). Depresión post ictus: Una actualización. Neurología, 30, 23-31. https://doi.org/10.1016/j.nrl.2012.06.008 |
| [18] | Fan, L., Quijano-Ruiz, A., Wang, C., Zhao, H., Wang, D., Wu, H. et al. (2024). Effects of Personalized Music Listening on Post-Stroke Cognitive Impairment: A Randomized Controlled Trial. Complementary Therapies in Clinical Practice, 57, Article ID: 101885. https://doi.org/10.1016/j.ctcp.2024.101885 |
| [19] | Fu, Q., Qiu, R., Chen, L., Chen, Y., Qi, W., & Cheng, Y. (2023). Music Prevents Stress-Induced Depression and Anxiety-Like Behavior in Mice. Translational Psychiatry, 13, Article No. 317. https://doi.org/10.1038/s41398-023-02606-z |
| [20] | Gyagenda, J. O., Ddumba, E., Odokonyero, R., Kaddumukasa, M., Sajatovic, M., Smyth, K. et al. (2015). Post-Stroke Depression among Stroke Survivors Attending Two Hospitals in Kampala Uganda. African Health Sciences, 15, 1220-1231. https://doi.org/10.4314/ahs.v15i4.22 |
| [21] | Hadidi, N. N., Huna Wagner, R. L., & Lindquist, R. (2017). Nonpharmacological Treatments for Post-Stroke Depression: An Integrative Review of the Literature. Research in Gerontological Nursing, 10, 182-195. https://doi.org/10.3928/19404921-20170524-02 |
| [22] | Hernandez-Ruiz, E., & Dvorak, A. L. (2021). Music Stimuli for Mindfulness Practice: A Replication Study. Journal of Music Therapy, 58, 155-176. https://doi.org/10.1093/jmt/thaa018 |
| [23] | Jun, E., Roh, Y. H., & Kim, M. J. (2013). The Effect of Music‐Movement Therapy on Physical and Psychological States of Stroke Patients. Journal of Clinical Nursing, 22, 22-31. https://doi.org/10.1111/j.1365-2702.2012.04243.x |
| [24] | Kaiser, A. P., & Berntsen, D. (2023). The Cognitive Characteristics of Music‐Evoked Autobiographical Memories: Evidence from a Systematic Review of Clinical Investigations. WIREs Cognitive Science, 14, e1627. https://doi.org/10.1002/wcs.1627 |
| [25] | Kim, D. S., Park, Y. G., Choi, J. H., Im, S., Jung, K. J., Cha, Y. A. et al. (2011). Effects of Music Therapy on Mood in Stroke Patients. Yonsei Medical Journal, 52, 977-981. https://doi.org/10.3349/ymj.2011.52.6.977 |
| [26] | Kulinski, J., Ofori, E. K., Visotcky, A., Smith, A., Sparapani, R., & Fleg, J. L. (2022). Effects of Music on the Cardiovascular System. Trends in Cardiovascular Medicine, 32, 390-398. https://doi.org/10.1016/j.tcm.2021.06.004 |
| [27] | Kuot, A., Barton, E., Tiri, G., McKinlay, T., Greenhill, J., & Isaac, V. (2021). Personalised Music for Residents with Dementia in an Australian Rural Aged‐Care Setting. Australian Journal of Rural Health, 29, 71-77. https://doi.org/10.1111/ajr.12691 |
| [28] | Liao, W., Chen, D., Wu, J., Liu, K., Feng, J., Li, H. et al. (2023). Risk Factors for Post-Stroke Depression in Patients with Mild and Moderate Strokes. Medicine, 102, e34157. https://doi.org/10.1097/md.0000000000034157 |
| [29] | Loubinoux, I., Kronenberg, G., Endres, M., Schumann‐Bard, P., Freret, T., Filipkowski, R. K. et al. (2012). Post‐Stroke Depression: Mechanisms, Translation and Therapy. Journal of Cellular and Molecular Medicine, 16, 1961-1969. https://doi.org/10.1111/j.1582-4934.2012.01555.x |
| [30] | Mao, Y., Tao, X., Zhang, G., & Chen, H. (2024). Effect of Music Therapy on Negative Psychology, Sleep, and Quality of Life in Elderly Patients Recovering from Cerebral Infarction with Depression and Anxiety: A Retrospective Analysis. Noise and Health, 26, 430-435. https://doi.org/10.4103/nah.nah_84_24 |
| [31] | Medeiros, G. C., Roy, D., Kontos, N., & Beach, S. R. (2020). Post-stroke Depression: A 2020 Updated Review. General Hospital Psychiatry, 66, 70-80. https://doi.org/10.1016/j.genhosppsych.2020.06.011 |
| [32] | Ning, M., Wen, S., Zhou, P., & Zhang, C. (2022). Ventral Tegmental Area Dopaminergic Action in Music Therapy for Post-Traumatic Stress Disorder: A Literature Review. Frontiers in Psychology, 13, Article 1014202. https://doi.org/10.3389/fpsyg.2022.1014202 |
| [33] | Paolucci, S. (2017). Advances in Antidepressants for Treating Post-Stroke Depression. Expert Opinion on Pharmacotherapy, 18, 1011-1017. https://doi.org/10.1080/14656566.2017.1334765 |
| [34] | Raggi, A., Serretti, A., & Ferri, R. (2024). A Comprehensive Overview of Post-Stroke Depression Treatment Options. International Clinical Psychopharmacology, 39, 127-138. https://doi.org/10.1097/yic.0000000000000532 |
| [35] | Rushing, J., Capilouto, G., Dressler, E. V., Gooding, L. F., Lee, J., & Olson, A. (2022). Active Music Therapy Following Acute Stroke: A Single-Arm Repeated Measures Study. Journal of Music Therapy, 59, 36-61. https://doi.org/10.1093/jmt/thab017 |
| [36] | Sarkamo, T., Tervaniemi, M., Laitinen, S., Forsblom, A., Soinila, S., Mikkonen, M. et al. (2008). Music Listening Enhances Cognitive Recovery and Mood after Middle Cerebral Artery Stroke. Brain, 131, 866-876. https://doi.org/10.1093/brain/awn013 |
| [37] | Sumakul, V. D. O., Notobroto, H. B., Widani, N. L., & Aima, M. H. (2020). Instrumental Music Therapy Reduced Depression Levels in Stroke Patients. Journal of Public Health Research, 9, Article No. 1847. https://doi.org/10.4081/jphr.2020.1847 |
| [38] | Sun, J., Zhou, X., Ren, B., Guo, Y., Xu, Q., Wang, Q. et al. (2024). Effects of Acupuncture Combined with Five-Element Music for People with Mild/Moderate Post-Stroke Depression: A Randomized Controlled Trial. Complementary Therapies in Medicine, 86, Article ID: 103088. https://doi.org/10.1016/j.ctim.2024.103088 |
| [39] | Sun, S., Li, Z., Xiao, Q., Tan, S., Hu, B., & Jin, H. (2023). An Updated Review on Prediction and Preventive Treatment of Post-Stroke Depression. Expert Review of Neurotherapeutics, 23, 721-739. https://doi.org/10.1080/14737175.2023.2234081 |
| [40] | Thompson, N., Bloska, J., Abington, A., Masterson, A., Whitten, D., & Street, A. (2022). The Feasibility and Acceptability of Neurologic Music Therapy in Subacute Neurorehabilitation and Effects on Patient Mood. Brain Sciences, 12, Article 497. https://doi.org/10.3390/brainsci12040497 |
| [41] | Villa, R. F., Ferrari, F., & Moretti, A. (2018). Post-Stroke Depression: Mechanisms and Pharmacological Treatment. Pharmacology & Therapeutics, 184, 131-144. https://doi.org/10.1016/j.pharmthera.2017.11.005 |
| [42] | Wang, Z., Xue, Y., Sun, G., Yun, J., Li, Y., Chen, Q. et al. (2025). Effects of Music-Supported Therapy (MST) for Depression and Cognitive Disorders in People Living with Stroke and Its Impact on Quality of Life: A Systematic Evaluation and Meta-Analysis. Cerebrovascular Diseases. https://doi.org/10.1159/000543361 |
| [43] | Wijeratne, T., Sales, C., & Wijeratne, C. (2022). A Narrative Review on the Non-Pharmacologic Interventions in Post-Stroke Depression. Psychology Research and Behavior Management, 15, 1689-1706. https://doi.org/10.2147/prbm.s310207 |
| [44] | Yi, J., Lu, J., Yang, A., & Marsh, E. B. (2022). In-Hospital Predictors of Post-Stroke Depression for Targeted Initiation of Selective Serotonin Reuptake Inhibitors (SSRIs). BMC Psychiatry, 22, Article No. 722. https://doi.org/10.1186/s12888-022-04378-0 |
| [45] | Zhang, J., Zhao, Y., Li, H., Yang, Y., & Tang, Q. (2024). Effectiveness of Acupuncture Plus Music Therapy for Post-Stroke Depression: Systematic Review and Meta-Analysis. Medicine, 103, e39681. https://doi.org/10.1097/md.0000000000039681 |
| [46] | Zhao, L., Lyu, X., Jiang, H., & Gao, X. (2022). Musicokinetic and Exercise Therapies Decrease the Depression Level of Elderly Patients Undergoing Post-Stroke Rehabilitation: The Moderating Effect of Health Regulatory Focus. Frontiers in Psychology, 13, Article 889510. https://doi.org/10.3389/fpsyg.2022.889510 |
| [47] | Zhong, K., An, X., & Kong, Y. (2024). The Effectiveness of Five-Element Music Therapy for Post-Stroke Depression: A Systematic Review and Meta-Analysis. Heliyon, 10, e26603. https://doi.org/10.1016/j.heliyon.2024.e26603 |
