title: Effect of antidepressants on the course of disability following stroke.
abstract: OBJECTIVE
  Stroke often produces marked physical and cognitive impairments leading to functional dependence, caregiver burden, and poor quality of life. We examined the course of disability during a 1-year follow-up period after stroke among patients who were administered antidepressants for 3 months compared to patients given placebo for 3 months.
  
  
  METHODS
  A total of 83 patients entered a double-blind randomized study of the efficacy of antidepressants to treat depressive disorders and reduce disability after stroke. Patients were assigned to either fluoxetine (N = 32), nortriptyline (N = 22) or placebo (N = 29). Psychiatric assessment included administration of the Present State Examination modified to identify DSM-IV symptoms of depression. The severity of depression was measured using the 17-item Hamilton Depression Rating Scale. The modified Rankin Scale was used to evaluate the disability of patients at initial evaluation and at quarterly follow-up visits for 1 year. Impairment in activities of daily living was assessed by Functional Independence Measure at the same time.
  
  
  RESULTS
  During the 1-year follow-up period, and after adjusting for critical confounders including age, intensity of rehabilitation therapy, baseline stroke severity, and baseline Hamilton Depression Rating Scale, patients who received fluoxetine or nortriptyline had significantly greater improvement in modified Rankin Scale scores compared to patients who received placebo (t [156] = -3.17, p = 0.002).
  
  
  CONCLUSIONS
  Patients treated with antidepressants had better recovery from disability by 1-year post stroke (i.e., 9 months after antidepressants were stopped) than patients who did not receive antidepressant therapy. This effect was independent of depression suggesting that antidepressants may facilitate the neural mechanisms of recovery in patients with stroke.
authors.affiliation: Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, IA 52242, USA.
authors.forename: Katsunaka
authors.initials: K
authors.lastname: Mikami
authors.forename: Ricardo E
authors.initials: RE
authors.lastname: Jorge
authors.forename: Harold P
authors.initials: HP
authors.lastname: Adams
authors.forename: Patricia H
authors.initials: PH
authors.lastname: Davis
authors.forename: Enrique C
authors.initials: EC
authors.lastname: Leira
authors.forename: Mijin
authors.initials: M
authors.lastname: Jang
authors.forename: Robert G
authors.initials: RG
authors.lastname: Robinson
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000150:complications / Q000188:drug therapy* / Q000523:psychology*; D004185:Disability Evaluation; D004311:Double-Blind Method; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009661:Nortriptyline / Q000627:therapeutic use; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D000071939:Stroke Rehabilitation
chemical_list: D000928:Antidepressive Agents; D005473:Fluoxetine; D009661:Nortriptyline