Yan Chen1, Jeff J Guo, Siyan Zhan, Nick C Patel. 1. Pharmacoepidemiology and Pharmacoeconomics, Department of Pharmacy Practice and Administrative Sciences, School of Pharmacy, University of Cincinnati Medical Center, Cincinnati, OH 45267-0004, USA. Yance@email.uc.edu
Abstract
BACKGROUND: Appropriate treatment of post-stroke depression (PSD) is critically important, considering the negative impact of PSD. Data regarding the treatment efficacy of antidepressants in patients with PSD are conflicting, and the time-dependent effects of antidepressant treatment in this population are unknown. OBJECTIVE: To systematically assess treatment effects of antidepressants in patients with PSD, incorporating data from recent studies. METHODS: A meta-analysis of randomized placebo-controlled trials (RCTs) of antidepressants in patients with PSD was conducted, using published studies from 1984 to 2006. Outcome measures of antidepressant treatment included response rate, depression rating scale scores, recovery of neurologic impairments, and improvements in activities of daily living (ADLs) after stroke. The effect size was presented as rate difference (RD) and weighted mean difference for dichotomous outcomes and continuous outcomes, respectively. Pooled effect sizes were calculated by both fixed-effects and random-effects models. RESULTS: A total of 1320 patients who met inclusion criteria were identified from 16 RCTs. The pooled response rates in the active and placebo groups were 65.18% (234/359) and 44.37% (138/311), respectively. The pooled RD was 0.23 (95% CI 0.03 to 0.43), indicating a significantly higher response rate in the active group compared with the placebo group. From baseline to endpoint, patients in the active group had significantly greater improvement in depressive symptoms compared with patients in the placebo group. Longer duration of treatment was positively correlated with the degree of improvement in depressive symptoms (Spearman's correlation, [rho] = -0.93, p = 0.001). No consistent evidence was found for positive antidepressant effects on the recovery of neurologic impairments and improvements in ADLs. CONCLUSIONS: The results of this meta-analysis suggest that use of antidepressants among patients with a diagnosis of PSD is associated with improvement in depressive symptoms. Longer durations of antidepressant treatment may be associated with greater reductions in depressive symptoms.
BACKGROUND: Appropriate treatment of post-stroke depression (PSD) is critically important, considering the negative impact of PSD. Data regarding the treatment efficacy of antidepressants in patients with PSD are conflicting, and the time-dependent effects of antidepressant treatment in this population are unknown. OBJECTIVE: To systematically assess treatment effects of antidepressants in patients with PSD, incorporating data from recent studies. METHODS: A meta-analysis of randomized placebo-controlled trials (RCTs) of antidepressants in patients with PSD was conducted, using published studies from 1984 to 2006. Outcome measures of antidepressant treatment included response rate, depression rating scale scores, recovery of neurologic impairments, and improvements in activities of daily living (ADLs) after stroke. The effect size was presented as rate difference (RD) and weighted mean difference for dichotomous outcomes and continuous outcomes, respectively. Pooled effect sizes were calculated by both fixed-effects and random-effects models. RESULTS: A total of 1320 patients who met inclusion criteria were identified from 16 RCTs. The pooled response rates in the active and placebo groups were 65.18% (234/359) and 44.37% (138/311), respectively. The pooled RD was 0.23 (95% CI 0.03 to 0.43), indicating a significantly higher response rate in the active group compared with the placebo group. From baseline to endpoint, patients in the active group had significantly greater improvement in depressive symptoms compared with patients in the placebo group. Longer duration of treatment was positively correlated with the degree of improvement in depressive symptoms (Spearman's correlation, [rho] = -0.93, p = 0.001). No consistent evidence was found for positive antidepressant effects on the recovery of neurologic impairments and improvements in ADLs. CONCLUSIONS: The results of this meta-analysis suggest that use of antidepressants among patients with a diagnosis of PSD is associated with improvement in depressive symptoms. Longer durations of antidepressant treatment may be associated with greater reductions in depressive symptoms.
Authors: Pamela H Mitchell; Richard C Veith; Kyra J Becker; Ann Buzaitis; Kevin C Cain; Michael Fruin; David Tirschwell; Linda Teri Journal: Stroke Date: 2009-08-06 Impact factor: 7.914
Authors: Gabrielle M Harris; Janice Collins-McNeil; Qing Yang; Vu Q C Nguyen; Mark A Hirsch; Charles F Rhoads; Tami Guerrier; J George Thomas; Terrence M Pugh; Deanna Hamm; Carol Pereira; Janet Prvu Bettger Journal: J Stroke Cerebrovasc Dis Date: 2016-10-06 Impact factor: 2.136
Authors: Yejin Lee; Brian Chen; Mandy W M Fong; Jin-Moo Lee; Ginger E Nicol; Eric J Lenze; Lisa T Connor; Carolyn Baum; Alex W K Wong Journal: Top Stroke Rehabil Date: 2020-08-12 Impact factor: 2.119