title: Is left stroke a risk-factor for selective serotonin reuptake inhibitor antidepressant treatment resistance?
abstract: The objective of the study was to detect changes of depression and cognitive level associated with right and left brain damage during SSRI treatment in subjects with post-stroke Major Depressive Disorder (MDD). After the baseline evaluation, the 45 patients included received a single oral dose of 20-40 mg of fluoxetine or 50-100 mg of sertraline. At day 0, 7, 14, 28, 42, and 56 a psychometric test battery comprising the Hamilton Depression Rating Scale (HDRS) and the Mini Mental State Examination (MMSE) was administered. In the whole group repeated measures ANOVAs revealed a highly significant (p < 0.0001) time effect for HDRS and MMSE scores. However, depression improved much more in right stroke subjects in comparison with left stroke subjects (p < 0.001 for the HDRS by laterality interaction). Moreover, there is a suggestion of a possible selective serotonin reuptake inhibitor (SSRI) efficacy in cognitive impairment associated to post-stroke MDD but in treatment-responders only. At the endpoint, chi-square analysis showed that there was a different prevalence rate of MDD between left (n = 10; 50 %) and right (n = 4; 16 %) stroke patients, whereas the prevalence rate of Minor Depression was identical (25 %). The SSRIs fluoxetine and sertraline could be efficacious treatments for post-stroke MDD but these findings suggest that left stroke could be a predictor of treatment resistance.
authors.affiliation: I.R.C.C.S., Fondazione Santa Lucia, Rome, Italy. g.spalletta@hsantalucia.it
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Spalletta
authors.forename: Giovanni
authors.initials: G
authors.lastname: Guida
authors.forename: Carlo
authors.initials: C
authors.lastname: Caltagirone
mesh_terms: D000284:Administration, Oral; D000368:Aged; D003071:Cognition; D003866:Depressive Disorder / Q000188:drug therapy*; D004351:Drug Resistance; D005260:Female; D005473:Fluoxetine / Q000008:administration & dosage / Q000494:pharmacology*; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000494:pharmacology*; D020280:Sertraline / Q000008:administration & dosage / Q000494:pharmacology*; D020521:Stroke / Q000150:complications*
chemical_list: D005473:Fluoxetine; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline