Management of depression after stroke: a systematic review of pharmacological therapies.
OBJECTIVE
Although depression may affect recovery and outcome after stroke, it is often overlooked or inadequately managed, and there is uncertainty regarding the benefits of antidepressant therapy in this setting. We aimed to assess the effectiveness of antidepressants for the treatment and prevention of depression after stroke.


METHODS
We undertook a systematic review using Cochrane methods of randomized placebo-controlled trials of antidepressants for the treatment or prevention of depressive illness and "abnormal mood" after stroke. Treatment effects on physical and other outcomes were also examined.


RESULTS
Outcome data were available for 7 treatment trials including 615 patients and 9 prevention trials including 479 patients. Because of the considerable variation in research design, trial quality, and method of reporting across studies, we did not pool all the outcome data. In the treatment trials, antidepressants reduced mood symptoms but had no clear effect on producing a remission of diagnosable depressive illness. There was no definitive evidence that antidepressants prevent depression or improve recovery after stroke.


CONCLUSIONS
There is insufficient randomized evidence to support the routine use of antidepressants for the prevention of depression or to improve recovery from stroke. Although antidepressants may improve mood in stroke patients with depression, it is unclear how clinically significant such modest effects are in patients other than those with major depression. There is a pressing need for further research to better define the role of antidepressants in stroke management.
Hackett
Maree L
ML
The George Institute for International Health, Neurological Diseases and Ageing Division, affiliated with the Royal Prince Alfred Hospital and the University of Sydney, Australia. mhackett@thegeorgeinstitute.org
Anderson
Craig S
CS
House
Allan O
AO
D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D003863:Depression / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000150:complications*; D016896:Treatment Outcome
D000928:Antidepressive Agents