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NEUROLOGY

Treatment Effects of Antidepressants in Patients with Post-Stroke Depression: A Meta-Analysis

Research Associate, Pharmacoepidemiology and Pharmacoeconomics, Department of Pharmacy Practice and Administrative Sciences, School of Pharmacy, University of Cincinnati Medical Center, Cincinnati, OH

Jeff J Guo, PhD

Associate Professor, Pharmacoepidemiology and Pharmacoeconomics, Department of Pharmacy Practice and Administrative Sciences, School of Pharmacy, University of Cincinnati Medical Center

Siyan Zhan, MPH PhD

Professor of Epidemiology, School of Public Health, Peking University, People's Republic of China

Nick C Patel, PharmD PhD

Assistant Professor, Pharmacy and Psychiatry; Director, Division of Clinical Trials, Psychiatry, University of Cincinnati Medical Center.

Reprints: Mr. Chen, Department of Pharmacy Practice and Administrative Sciences, School of Pharmacy, University of Cincinnati Medical Center, 3225 Eden Ave., Cincinnati, OH 45267-0004, fax 513/558-4372, Yance{at}email.uc.edu.

BACKGROUND: Appropriate treatment of post-stroke depression (PSD) is critically important, considering the negative impact of PSD. Data regarding the treatment efficacy of antidepressants in patients with PSD are conflicting, and the time-dependent effects of antidepressant treatment in this population are unknown.

OBJECTIVE: To systematically assess treatment effects of antidepressants in patients with PSD, incorporating data from recent studies.

METHODS: A meta-analysis of randomized placebo-controlled trials (RCTs) of antidepressants in patients with PSD was conducted, using published studies from 1984 to 2006. Outcome measures of antidepressant treatment included response rate, depression rating scale scores, recovery of neurologic impairments, and improvements in activities of daily living (ADLs) after stroke. The effect size was presented as rate difference (RD) and weighted mean difference for dichotomous outcomes and continuous outcomes, respectively. Pooled effect sizes were calculated by both fixed-effects and random-effects models.

RESULTS: A total of 1320 patients who met inclusion criteria were identified from 16 RCTs. The pooled response rates in the active and placebo groups were 65.18% (234/359) and 44.37% (138/311), respectively. The pooled RD was 0.23 (95% CI 0.03 to 0.43), indicating a significantly higher response rate in the active group compared with the placebo group. From baseline to endpoint, patients in the active group had significantly greater improvement in depressive symptoms compared with patients in the placebo group. Longer duration of treatment was positively correlated with the degree of improvement in depressive symptoms (Spearman's correlation, [] = -0.93, p = 0.001). No consistent evidence was found for positive antidepressant effects on the recovery of neurologic impairments and improvements in ADLs.

CONCLUSIONS: The results of this meta-analysis suggest that use of antidepressants among patients with a diagnosis of PSD is associated with improvement in depressive symptoms. Longer durations of antidepressant treatment may be associated with greater reductions in depressive symptoms.

Key Words: antidepressants, post-stroke depression

Published Online, November 21, 2006. www.theannals.com, DOI 10.1345/aph.1H389