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(Stroke. 2005;36:1092.)
© 2005 American Heart Association, Inc.

Progress Review

Management of Depression After Stroke

A Systematic Review of Pharmacological Therapies

From The George Institute for International Health (M.L.H., C.S.A.), Neurological Diseases and Ageing Division, affiliated with the Royal Prince Alfred Hospital and the University of Sydney, Australia; and Academic Unit of Psychiatry and Behavioural Sciences (A.O.H.), University of Leeds, United Kingdom.

Correspondence to Maree Hackett, The George Institute for International Health, PO Box M201 Missenden Road, Sydney, NSW 2050, Australia. E-mail mhackett{at}thegeorgeinstitute.org

Background and Purpose— Although depression may affect recovery and outcome after stroke, it is often overlooked or inadequately managed, and there is uncertainty regarding the benefits of antidepressant therapy in this setting. We aimed to assess the effectiveness of antidepressants for the treatment and prevention of depression after stroke.

Methods— We undertook a systematic review using Cochrane methods of randomized placebo-controlled trials of antidepressants for the treatment or prevention of depressive illness and "abnormal mood" after stroke. Treatment effects on physical and other outcomes were also examined.

Results— Outcome data were available for 7 treatment trials including 615 patients and 9 prevention trials including 479 patients. Because of the considerable variation in research design, trial quality, and method of reporting across studies, we did not pool all the outcome data. In the treatment trials, antidepressants reduced mood symptoms but had no clear effect on producing a remission of diagnosable depressive illness. There was no definitive evidence that antidepressants prevent depression or improve recovery after stroke.

Conclusions— There is insufficient randomized evidence to support the routine use of antidepressants for the prevention of depression or to improve recovery from stroke. Although antidepressants may improve mood in stroke patients with depression, it is unclear how clinically significant such modest effects are in patients other than those with major depression. There is a pressing need for further research to better define the role of antidepressants in stroke management.

Key Words: clinical trials • depression

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