Prediction of the response to citalopram and reboxetine in post-stroke depressed patients.
OBJECTIVE
Depression is a significant complication of stroke. The effectiveness of antidepressant drugs in the management of post-stroke depression (PSD) has been widely investigated. However, the choice of antidepressant drug is critically influenced by its safety and tolerability and by its effect on concurrent pathologies. Here we investigate the efficacy and safety of a selective serotonin reuptake inhibitor (SSRI), citalopram, and a noradrenaline reuptake inhibitor (NARI), reboxetine, in post-stroke patients affected by anxious depression or retarded depression.


METHODS
This was a randomized double-blind study. Seventy-four post-stroke depressed patients were diagnosed as affected by anxious or retarded depression by using a synoptic table. Randomisation was planned so that 50% of the patients in each subgroup were assigned for 16 weeks to treatment with citalopram and the remaining 50% were assigned to treatment with reboxetine. The Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale (HDRS) and a synoptic table were used to score depressive symptoms.


RESULTS
Both citalopram and reboxetine showed good safety and tolerability. Citalopram exhibited greater efficacy in anxious depressed patients, while reboxetine was more effective in retarded depressed patients.


CONCLUSIONS
Citalopram or other SSRIs and reboxetine may be of first choice treatment in PSD because of their good efficacy and lack of severe side effects. In addition, PSD patients should be classified according to their clinical profile (similarly to patients affected by primary depression) for the selection of SSRIs or reboxetine as drugs of choice in particular subgroups of patients.
Rampello
Liborio
L
Department of Neurosciences, Neurologia, Azienda Policlinico, University of Catania, via S. Sofia 78, 95123 Catania, Italy. rampello@unict.it
Chiechio
Santina
S
Nicoletti
Giovanni
G
Alvano
Alessandro
A
Vecchio
Ignazio
I
Raffaele
Rocco
R
Malaguarnera
Mariano
M
D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use; D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D015283:Citalopram / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy* / Q000209:etiology; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009025:Morpholines / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D000077593:Reboxetine; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications*; D016896:Treatment Outcome
D018759:Adrenergic Uptake Inhibitors; D015283:Citalopram; D009025:Morpholines; D000077593:Reboxetine; D017367:Selective Serotonin Reuptake Inhibitors