Post Stroke Depression - A Parallel arm randomized placebo controlled clinical trial analyzing the biocompatibility and therapeutic potential of unani formulation Habb-e-aftimoon

Post-stroke depression (PSD) is a prevalent neuropsychiatric complication, affecting up to one-third of stroke survivors, and is associated with impaired functional recovery, social isolation, diminished quality of life, suicidal tendencies, and considerable caregiver burden. Globally, stroke and depression are among the leading contributors to disability-adjusted life years. PSD has a reported prevalence of 25–79%, influenced by diagnostic criteria and patient selection. In Unani system of medicine, depression is not mentioned as an individual disease entity rather it is mentioned as a symptom or group of symptoms of Melancholy (Melancholia) in which the mental functions of the individual are deranged leading to constant grief, fear and dubious aggression, attributed to deranged black bile (ghair tabayi sauda) humor imbalance.Conventional pharmacotherapy, including SSRIs and TCAs, shows delayed onset, modest efficacy, and potential risk of stroke recurrence. Pathophysiology of PSD is multifactorial, involving decreased levels of monoamines, Increased neuro inflammation with dysregulation of hypothalamic - pituitary - adrenal axis, decreased neurotrophic support such as BDNF and glutamate mediated excitotoxicity. Habb e Aftimoon 5-10 g is considered to be therapeutically useful in malankhuliya and waswaas its actions are Munaqqi e dimagh (drugs clearing vitiated humour from brain) and Mulaiyin (laxative).