Efficacy and feasibility of antidepressant treatment in patients with post-stroke depression.
BACKGROUND
Depression greatly impacts the quality of life in most stroke survivors. Therefore, effective treatment of post-stroke depression (PSD) is critically important. However, evidence supporting the effectiveness and feasibility of antidepressant treatment in this population is limited and somewhat confusing.


METHODS
A comprehensive literature search of the Cochrane, PubMed, Web of Science, and Embase databases from inception up to November 2015 was conducted. We reviewed all randomized controlled trials (RCTs) that assigned patients with a clinical diagnosis of PSD to antidepressant or placebo treatment. Reduction in depression rating scale scores and response rate to antidepressants were defined as the efficacy outcomes. Rates of dropout for any reason and for adverse effects were defined as the acceptability outcomes. We also assessed improvements in activities of daily living (ADL) as functional outcomes.


RESULTS
In total, 11 trials consisting of 740 participants were indentified. A significant advantage of antidepressants compared with placebo treatment in PSD was observed in overall pooled effect size analysis (SMD = -0.96; 95% CI = -1.41 to -0.51; P <0.0001). In addition, patients receiving antidepressants presented a much greater improvement in various depressive symptoms than those with placebo (RR = 1.36; 95% CI = 1.01-1.83; P = 0.04). However, antidepressants were less well tolerated than placebo because of some adverse events (RR = 2.72; 95% CI = 1.37-5.43; P = 0.04). Intriguingly, no consistent evidence was found for a positive effect of antidepressants on ADL in our analysis.


CONCLUSIONS
This meta-analysis suggests that antidepressants treatment confers potentially positive effects in patients with PSD as compared with simple placebo treatment. However, this must be carefully considered in light of its possible adverse events in some individual patients.
Department of Neurology, The First Affiliated Hospital of Chongqing Medical University Chongqing Key Laboratory of Neurobiology, Chongqing Department of Neurology, Luzhou People's Hospital, Sichuan, China.
Xiao-Min
XM
Xu
De-Zhi
DZ
Zou
Liu-Yan
LY
Shen
Yang
Y
Liu
Xin-Yu
XY
Zhou
Jun-Cai
JC
Pu
Mei-Xue
MX
Dong
You-Dong
YD
Wei
D000203:Activities of Daily Living; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy* / Q000209:etiology*; D005240:Feasibility Studies; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000150:complications*; D016896:Treatment Outcome
D000928:Antidepressive Agents