Heterocyclics and selective serotonin reuptake inhibitors in the treatment and prevention of poststroke depression

OBJECTIVES: To review the best current evidence on heterocyclic and serotonin-reuptake inhibitor (SSRI) treatments of poststroke depression (PSD). DESIGN: A literature review using multiple databases was conducted to identify randomized, controlled trials of the treatment or prevention of PSD. Odds ratios were used to test for significant treatment response between the treatment arms for dichotomous outcomes. Continuous outcome measures were evaluated using weighted mean difference and 95% confidence intervals. SETTING: Literature review. PARTICIPANTS: Patients with stroke enrolled in the study of PSD of each selected article. MEASUREMENTS: Frequency of patients with and without depression; frequency of patients who responded to treatment. RESULTS: Nine articles were reviewed. Six investigated use of antidepressant therapy on treatment of PSD, and three examined the prevention of PSD. There was evidence to suggest that patients responded to treatment with antidepressants and significantly improved on depression scales, but treatment, especially with heterocyclic antidepressants, led to a significant number of dropouts due to side effects. There were insufficient data to pool the results of the prevention-based studies. CONCLUSION: Treatment with heterocyclic antidepressants and SSRIs appears to be a viable option for PSD, but their absolute or relative efficacy has yet to be fully established. The effectiveness of early initiation of antidepressants in the prevention of PSD is not clear.