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-)

Reference

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)

Funding

Foundation

Allocation

Concealed

Setting

Inpatient (any location) with outpatient follow-up

Synopsis

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.