Pharmacologic treatment options for post-stroke depression focused on selective

Abstract

Post-stroke depression (PSD) affects 20 to 50 percent of patients within one year after stroke. Depression is considered to be the most common emotional outcome of stroke. PSD is often not detected or inadequately treated. There is little evidence in the literature to guide health-care providers in regard to selection of pharmacological treatment. This study will focus on the efficacy and safety of selective serotonin reuptake inhibitors (SSRIs) versus tricyclic antidepressants (TCAs) in the treatment of PSD.

Methodology: An evidence-based systematic review of the current literature was conducted utilizing multiple electronic databases to identify randomized, controlled trials of the treatment of PSD. MESH terms used were poststroke depression, cerebrovascular accident AND depression, stroke AND depression, antidepressant treatment after stroke.

Results: 22 articles were selected for review. 14 out of those were randomized-controlled trials (RCTs) that were closely reviewed for recommendations regarding treatment of PSD. The class of drug with the largest number of RCTs was SSRIs, followed by the TCAs, and other antidepressants. TCAs and SSRIs appear to be equally effective in the treatment of PSD; however, a Grade A recommendation can be made in favor of SSRIs due to improved tolerability and significantly reduced side effect potential. In addition, the drug with the most RCTs supporting its use in PSD was fluoxetine.

Conclusion: SSRIs prove to have the greatest amount of clinical data to support their use and appear to be the preferred treatment option for PSD. Further trials with larger sample sizes and longer duration of treatment are needed to provide specific treatment recommendations to practitioners.