Selective Serotonin Reuptake Inhibitors for the Prevention of Post-Stroke Depression: A Systematic Review and Meta-Analysis

Richter, Daniel; James, Jeyanthan Charles; Ebert, Andreas D.; Katsanos, Aristeidis H.; Mazul-Wach, Lisa; Ruland, Quirin; Gold, Ralf; Juckel, Georg; Krogias, Christos

doi:10.3390/jcm10245912

Cited by 19 publications

(10 citation statements)

References 21 publications

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“…Thus, albeit the recognition of this new evidence suggests that off-label use of ADT can be expected to decrease, it might yet have contributed to the overtreatment in our sample. At the same time, the early use of SSRI could play a role in PSD prevention, as shown in a recent metaanalysis [13]. The authors found that early SSRI therapy significantly lowers PSD incidence (prevention) but to the disadvantage of increased risk of bone fractures and nausea.…”

Section: Discussionmentioning

confidence: 88%

“…Previous evidence of clinical trials suggests that antidepressant treatment (ADT)-especially selective serotonin reuptake inhibitors (SSRI)-can be an effective agent to treat PSD or lower the risk to develop depressive symptoms after stroke [9][10][11][12][13]. Although treatment guidelines concordantly emphasize the need of early identification followed by swift and evidence-based treatment of PSD [14][15][16], PSD still remains underdiagnosed and undertreated [5,17,18].…”

Section: Introductionmentioning

confidence: 99%

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Too Much and Too Little: Antidepressant Treatment in Stroke Survivors during the First Year

Werheid¹,

Volz²,

Ladwig³

et al. 2022

J. Integr. Neurosci.

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Background: Post-stroke depression (PSD) is the most frequent mental illness after stroke, affecting about 30% of stroke survivors and hampering rehabilitation outcome. While current guidelines recommend monitored antidepressant treatment (ADT) in PSD, the limited precision between the use and need of ADT in clinical practice remains underassessed and poorly understood. Methods: Depression according to DSM criteria and ADT was assessed in n = 294 stroke survivors from two German rehabilitation centers about one, six, and twelve months after stroke. At each measurement occasion, PSD and current use of ADT was assessed, leading to four subgroups: PSD (yes/no) and ADT (yes/no). Frequencies of ADT and PSD were examined and analyzed with regard to depression severity (minor/major). Intra-individual trajectories were used to assess the persistence in ADT over-and undertreatment from a longitudinal perspective. Results: After one, 6 and 12 months, 36.7%, 31.1% and 25.5% of stroke survivors fulfilled the criteria for depression. Across all measurement occasions, 53% of depressed stroke survivors did not receive ADT, while 12% of the non-depressed did. ADT between stroke survivors with major or minor depression differed at baseline but not thereafter. Between 15-40% of the depressed without ADT experienced persisting undertreatment and 25-50% the non-depressed with ADT had not fulfilled depression criteria at an earlier time point. Conclusions: Depression occurred in one in three stroke survivors. Among these, only one in two received ADT, irrespective of PSD severity after discharge. In contrast, one in eight stroke survivors without depressive disorder received ADT, about half of them in the absence of earlier PSD. In conclusion, we found evidence of both under-and overtreatment of PSD with ADT, which emphasizes the need for a more stringent implementation of current PSD guideline recommendations.

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Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Too Much and Too Little: Antidepressant Treatment in Stroke Survivors during the First Year

Werheid¹,

Volz²,

Ladwig³

et al. 2022

J. Integr. Neurosci.

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“…Previous evidence underlined the need for early identification of PSD risk factors, which represents a promising strategy to address the timing issue and improve treatment use in PSD, which is characterized by both over- and undertreatment ( 12 , 13 ). Moreover, meta-analytic evidence demonstrated that psychosocial interventions and pharmacotherapy are efficacious for prevention of depression after stroke, albeit with an increased risk of nausea and bone fracture for pharmacotherapy ( 14 , 15 ). Hence, preventive interventions should be applied only in groups at high risk of PSD in order to save resources and avoid the occurrence of adverse medication effects in people with low risk.…”

Section: Introductionmentioning

confidence: 99%

Predictors of post-stroke depression: Validation of established risk factors and introduction of a dynamic perspective in two longitudinal studies

Ladwig

Werheid²,

Südmeyer³

et al. 2023

Front. Psychiatry

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IntroductionCerebral insults lead in many cases not only to cognitive impairment but also to disturbed emotionality. After stroke, one in three survivors develops a depression which impacts quality of life and rehabilitation. Meta-analyses have identified five main predictors of post-stroke depression (PSD): history of mental disorder, stroke severity, physical disability, cognitive impairment, and social support. However, these five established variables have never been conjointly investigated in a sample of stroke survivors. Therefore, their independent predictive values remain unclear. Moreover, predictors are most often used as time-invariant factors (status scores), neglecting the intraindividual dynamics after stroke.MethodsOur study analyses the data of two prospective longitudinal studies, investigating stroke survivors from two rehabilitation hospitals (N1 = 273) and one acute care hospital (N2 = 226). Baseline assessments included the five established predictors and depressive symptoms. After 6 months, depressive symptoms were reassessed in both studies (n1 = 176, n2 = 183), and physical disability and social support were reassessed in study 2. The predictivity of the five predictors and the additional predictivity of intraindividual dynamics for PSD were examined in multiple linear regression analyses.ResultsHistory of mental disorder was a risk factor for depressive symptoms after stroke at all measurement times (B = 3.32 to 3.97; p < 0.01). Physical disability was a risk factor at all measurement times (B = −0.09 to −0.03; p < 0.05) except 6 months after rehabilitation. Social support was a protective factor (B = −2.69 to −1.91; p < 0.01) outside the acute phase (R2 = 0.15–0.39). Intraindividual changes in physical disability and perceived social support were independent predictors of PSD 6 months after the acute phase (B = −0.08/−0.14; p < 0.01), in addition to status scores on established variables (ΔR2 = 0.08, p < 0.001).DiscussionHistory of mental disorder, physical disability, and social support are independent predictors of depressive symptoms in the first year post-stroke, also when considered conjointly. Future studies should control for these variables when investigating new predictors of PSD. In addition, intraindividual changes in known predictors after stroke play a relevant role in the pathogenesis of PSD and should be considered in clinical practice and future research.

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“…Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are frequently selected for the treatment of PSD. It is worth noting that SSRIs are first-choice drugs (Mortensen and Andersen, 2015 ), but many patients experience many adverse events with the treatment, such as the risk of bone fractures and nausea (Richter et al, 2021 ). Psychotherapy is commonly used in the treatment of PSD patients.…”

Section: Introductionmentioning

confidence: 99%

The efficacy of therapies for post-stroke depression in aging: An umbrella review

Xie

Geng²,

Fan³

et al. 2022

Front. Aging Neurosci.

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Post-stroke depression (PSD) is a common complication after stroke. PSD is associated with emotional disorders and psychological dependence, which are potential risk factors for stroke recurrence and suicidality. This study aimed to perform an umbrella review of therapies for PSD through a comprehensive literature search. A systematic search was conducted in the PubMed and Web of Science by two independent authors. We examined the Hamilton Depression Scale (HAMD), Activities of daily living (ADL), Neurologic function as efficacy endpoints, and the incidence of adverse events as safety profiles. Seventeen eligible studies, including 267 clinical trials were included in this study. The results showed that High-Frequency Repetitive Transcranial Magnetic Stimulation (HfrTMS), Acupuncture/EA+conventional treatment, Escitalopram, Modified Sini San, Moxibustion, Xiaoyao Formula, Paroxetine, Chinese herbal medicine, Exercise, Citalopram, and Cognitive behavioral therapy are beneficial for improving the depression symptoms of patients with PSD. HfrTMS and Sertraline may have an impact on slowing the scores of activities of daily living or neurologic function. In addition, Acupuncture/EA+conventional, Escitalopram, Citalopram, Sertraline, and Fluoxetine showed no serious adverse events in PSD patients. Our study demonstrated that 11 treatment methods can effectively improve the condition of PSD patients.

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Selective Serotonin Reuptake Inhibitors for the Prevention of Post-Stroke Depression: A Systematic Review and Meta-Analysis

Cited by 19 publications

References 21 publications

Too Much and Too Little: Antidepressant Treatment in Stroke Survivors during the First Year

Too Much and Too Little: Antidepressant Treatment in Stroke Survivors during the First Year

Predictors of post-stroke depression: Validation of established risk factors and introduction of a dynamic perspective in two longitudinal studies

The efficacy of therapies for post-stroke depression in aging: An umbrella review

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