Type your tag names separated by a space and hit enter

Escitalopram (Lexapro) reduces risk of poststroke depression


Clinical Question:
Does treatment of adults with escitalopram for the first year following an acute stroke reduce the risk of depression?

Bottom Line:
Escitalopram (Lexapro) reduces adults' risk developing depression in the first year following an acute stroke. Another study (Jorge RE, et al. Am J Psychiatry 2003;160:1823-829) also showed a benefit with fluoxetine (Prozac) and nortriptyline (Pamelor). (LOE = 1b-)

Robinson RG, Jorge RE, Moser DJ, et al. Escitalopram and problem-solving therapy for prevention of poststroke depression. A randomized controlled trial. JAMA 2008;299:2391-2400.  [PMID:18505948]

Study Design:
Randomized controlled trial (double-blinded)


Inpatient (any location) with outpatient follow-up

Poststroke depression is common in adults and increases mortality risk. These investigators identified 176 adults, aged 50 years to 90 years, who did not meet standard criteria for depression within 3 months of an acute stroke. Eligible patients randomly received (concealed allocation assignment) escitalopram (10 mg/d in the morning for patients younger than 65 years and 5 mg/day for patients older than 65 years), matched placebo, or problem-solving therapy. Problem-solving therapy consisted of 6 treatment sessions over the first 12 weeks with reinforcement sessions during months 4, 5, 6, 8, 10, and 12. One investigator audiotaped or video recorded all sessions for supervision and adherence ratings. During the sessions, patients learned to select a problem and go through a structured series of support steps to arrive at a course of action. The individuals who assessed outcomes remained masked to drug therapy assignment group but knew which patients were assigned to the problem-solving group. Standard DSM-IV criteria were used to diagnose subsequent depression. Follow-up occurred for 91% of patients at 1 year. Using intention-to-treat analysis, escitalopram significantly reduced the risk of depression compared with placebo (23.1% vs 34.5%; number needed to treat = 9). There was no significant difference in the risk of developing depression in the problem-solving therapy group compared with the placebo group. Adverse effects were mild and occurred at a similar rate in all 3 groups.

Escitalopram (Lexapro) reduces risk of poststroke depression is a sample topic from the EE+ POEM Archive.

To view other topics, please or purchase a subscription.

Evidence Central is an integrated web and mobile solution that helps clinicians quickly answer etiology, diagnosis, treatment, and prognosis questions using the latest evidence-based research. Learn more.


Slawson, David C., et al., editors. "Escitalopram (Lexapro) Reduces Risk of Poststroke Depression." EE+ POEM Archive, John Wiley & Sons, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/infoPOEMs/426541/all/Escitalopram__Lexapro__reduces_risk_of_poststroke_depression.
Escitalopram (Lexapro) reduces risk of poststroke depression. In: Slawson DC, Shaughnessy AF, Ebell MH, et al, eds. EE+ POEM Archive. John Wiley & Sons; 2019. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426541/all/Escitalopram__Lexapro__reduces_risk_of_poststroke_depression. Accessed July 16, 2019.
Escitalopram (Lexapro) reduces risk of poststroke depression. (2019). In Slawson, D. C., Shaughnessy, A. F., Ebell, M. H., & Barry, H. (Eds.), EE+ POEM Archive. Available from https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426541/all/Escitalopram__Lexapro__reduces_risk_of_poststroke_depression
Escitalopram (Lexapro) Reduces Risk of Poststroke Depression [Internet]. In: Slawson DC, Shaughnessy AF, Ebell MH, Barry H, editors. EE+ POEM Archive. John Wiley & Sons; 2019. [cited 2019 July 16]. Available from: https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426541/all/Escitalopram__Lexapro__reduces_risk_of_poststroke_depression.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Escitalopram (Lexapro) reduces risk of poststroke depression ID - 426541 ED - Slawson,David C, ED - Shaughnessy,Allen F, ED - Ebell,Mark H, ED - Barry,Henry, BT - EE+ POEM Archive UR - https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426541/all/Escitalopram__Lexapro__reduces_risk_of_poststroke_depression PB - John Wiley & Sons DB - Evidence Central DP - Unbound Medicine ER -