title: Prevention of poststroke depression: does prophylactic pharmacotherapy work?
abstract: BACKGROUND
  Given the negative influence of poststroke depression (PSD) on functional recovery, cognition, social participation, quality of life, and risk for mortality, the early initiation of antidepressant therapy to prevent its development has been investigated; however, individual studies have offered conflicting evidence. The present systematic review and meta-analysis examined available evidence from published randomized controlled trials (RCTs) evaluating the effectiveness of pharmacotherapy for the prevention of PSD to provide updated pooled analyses.
  
  
  METHODS
  Literature searches of 6 databases were performed for the years 1990 to 2011. RCTs meeting study inclusion criteria were evaluated for methodologic quality. Data extracted included the antidepressant therapy used, treatment timing and duration, method(s) of assessment, and study results pertaining to the onset of PSD. Pooled analyses were conducted.
  
  
  RESULTS
  Eight RCTs were identified for inclusion. Pooled analyses demonstrated reduced odds for the development of PSD associated with pharmacologic treatment (odds ratio [OR] 0.34; 95% confidence interval [CI] 0.22-0.53; P<.001), a treatment duration of 1 year (OR 0.31; 95% CI 0.18-0.56; P<.001), and the use of a selective serotonin reuptake inhibitor (OR 0.37; 95% CI 0.22-0.61; P<.001).
  
  
  CONCLUSIONS
  The early initiation of antidepressant therapy, in nondepressed stroke patients, may reduce the odds for development of PSD. Optimum timing and duration for treatment and the identification of the most appropriate recipients for a program of indicated prevention require additional examination.
authors.affiliation: Aging, Rehabilitation & Geriatric Care Program, Lawson Health Research Institute, Parkwood Hospital, London, Ontario, Canada. Electronic address: katherine.salter@sjhc.london.on.ca.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Salter
authors.forename: Norine C
authors.initials: NC
authors.lastname: Foley
authors.forename: Lynn
authors.initials: L
authors.lastname: Zhu
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Jutai
authors.forename: Robert W
authors.initials: RW
authors.lastname: Teasell
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000150:complications* / Q000523:psychology*
chemical_list: D000928:Antidepressive Agents