Efficacy of Antidepressants in Preventing Poststroke Depression: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 HANLin , CHENNing ,  HELi

Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

HELi, Email: heli2003new@126.com

Keywords：

Antidepressants; Poststroke depression; Prevention; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20150192

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the efficacy of antidepressants in the prevention of poststroke depression (PSD). Methods We searched The Cochrane Library (Issue 2, 2015), PubMed, MEDLINE, EMbase, CNKI and VIP databases to collect randomized controlled trials (RCTs) about antidepressants in preventing PSD from inception to April 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results A total of 26 RCTs involving 2 190 patients were included. The results of meta-analysis showed that:compared with the control group, the antidepressants group could significantly reduce the incidence of PSD (OR=0.24, 95%CI 0.17 to 0.36, P<0.000 01). Subgroup analysis based on types of drugs showed that:the selective serotonin reuptake Inhibitor (SSRI) could significantly reduce the incidence of PSD (OR=0.23, 95%CI 0.15 to 0.37, P<0.000 01). Subgroup analysis based on length of time showed that antidepressants could decrease the incidence of PSD in short term (OR=0.11, 95%CI 0.06 to 0.19, P<0.000 01), middle term (OR=0.31, 95%CI 0.21 to 0.46, P<0.000 01) and long term (OR=0.30, 95%CI 0.19 to 0.49, P<0.000 01). In addition, there was no statistical difference in the incidence of adverse effect between the antidepressants group and the control group (P>0.05). Conclusion Antidepressants is effective in the prevention of PSD, and may not affect patient's life quality. Due to the limited quantity and quality of included studies, more high quality studies are needed to verify the above conclusion.

Citation： HANLin, CHENNing, HELi. Efficacy of Antidepressants in Preventing Poststroke Depression: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2015, 15(10): 1153-1160. doi: 10.7507/1672-2531.20150192 Copy

1.	Yan H, Fang M, Liu XY. Role of microRNAs in stroke and poststroke depression. Scientific World Journal, 2013, 2:459692.
2.	Hackett ML, Anderson CS, House AO, et al. Management of depression after stroke:a systematic review of pharmacological therapies. Stroke, 2005, 36(5):1092-1097.
3.	Poynter B, Hon MS, Diaz-Granados N, et al. Sex differences in the prevalence of post-stroke depression:a Systematic Review. Psychosomatics, 2009, 50(6):563-569.
4.	Ayerbe L, Ayis S, Wolfe CD, et al. Natural history, predictors and outcomes of depression after stroke:systematic review and meta-analysis. Br J Psychiatry, 2013, 202(1):14-21.
5.	Loubinoux I, Kronenberg G, Endres M, et al. Post-stroke depression:mechanisms, translation and therapy. J Cell Mol Med, 2012, 16(9):1961-1969.
6.	Palomaki H, Kaste M, Berg A, et al. Prevention of poststroke depression:1 year rando-mised placebo controlled double blind trial of mianserin with 6 month follow up after therapy. J Neurol Neurosurg Psychiatry, 1999, 66(4):490-494.
7.	Katherine L, Salter BA, Norine C, et al. Prevention of poststroke depression:does prophylatic pharmacotherapy work? J Stroke and Cerebrovasc Dis, 2013, 22(8):1243-1251.
8.	中华医学会全国第四届脑血管病学术会议编年会. 脑卒中患者临床神经功能缺损程度评分标准. 中华神经科杂志, 1996, 29:381-383.
9.	American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th edition. DSM-Ⅳ. Washington, DC. APA, 1994.
10.	American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 3th edition. DSM-Ⅲ-R. Washington, DC. APA, 1987.
11.	世界卫生组织, 主编. 刘平, 许又新, 译. 精神与行为障碍分类:研究用诊断标准. 北京:人民卫生出版社, 1995:138-139.
12.	中华医学会精神科学会, 南京医科大学脑科医院, 主编. 中国精神疾病分类方案与诊断标准. 南京:东南大学出版社, 1995:107.
13.	中华医学会精神科分会, 主编. 中国精神障碍分类与诊断标准, 第3版. 济南:山东科学技术出版社, 2001:147-149.
14.	Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry, 1960, 23:56-62.
15.	Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand, 1983, 67:361-370.
16.	Montgomery SA, Asberg M. A new depression scale designed to be Sensitive to change. Br J Psychiatry, 1979, 134(6):382-389.
17.	Higgins JPT, Green S. Assessing risk of bias in included studies:Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. The Cochrane Collaboration, 2011, Available at:www.cochranehandbook.org.
18.	Almeida O, Wterreus A, Hankey G. Preventing depression after stroke:results from a randomized placebo-controlled trial. J Clin Psychiatry, 2006, 67(7):1104-1109.
19.	Chollet F, TardyJ, Albucher J, et al. Fluoxetine for motor recovery after acute ischaemic stroke (FLAME):a randomized placebo-controlled trial. Lancet Neurol, 2011, 10(2):123-130.
20.	Dam M, Tonin P, De Boni, A, et al. Effects of fluoxetine and maprotiline on functional recovery in poststroke hemiplegic patients undergoing rehabilitation therapy. Stroke, 1996, 27(7):1211-1214.
21.	Charles G, Becky R, Jay C, et al. Methylphenidate in early poststroke recovery:A double-blind, placebo-controlled study. Arch Phys Med Rehabil, 1998, 79(9):1047-1050.
22.	Yan K, Dong W, Liu C. Fluoxetine for poststroke depression a randomized placebo controlled clinical trial. NRR, 2007, 2(3):162-165.
23.	Mikami K, Jorge R, Moser D, et al. Prevention of poststroke apathy using escitalopram or problem-solving therapy. Am J Geriatr Psychiatry, 2013, 21(9):855-862.
24.	Narushima K, Kosier T, Robinson R. Preventing poststroke depression:A 12-week double-blind randomized treatment trial and 21-month follow-up. J Nerv and Ment Dis, 2002, 190(5):296-303.
25.	Niedermaier N, Bohrer E, Schulte K, et al. Prevention and treatment of poststroke depression with mirtazapine in patients with acute stroke. J Clin Psychiatry, 2004, 65(12):1619-1623.
26.	Raffaele R, Rampello L, Vecchio I, et al. Trazodone therapy of the post-stroke depression. Arch Gerontol Geriatr, 1996, 22(Suppl 1):217-220.
27.	Rasmussen A, Poulsen M, Poulsen DL, et al. A double-blind, placebo-controlled study of sertraline in the prevention of depression in stroke patients. Psychosomatics, 2003, 44(3):216-221.
28.	Robinson R, Susan K, Castillo C, et al. Nortriptyline versus fluoxetine in the treatment of depression and in short-term recovery after stroke:A placebo-controlled, double-blind study. Am J Psychiatry, 2000, 157(3):351-359.
29.	Robinson RG, Jorge RE, Moser DJ, et al. Escitalopram and problem-solving therapy for prevention of poststroke depression. JAMA, 2008, 299(20):2391-2400.
30.	Roh J, Lee K, Kim M, et al. Accelerated recovery from ischemic stroke with indeloxazine hydrochloride:results of a double-masked clinical study in Korea. Curr Ther Res, 1996, 57(8):632-642.
31.	Tsai CS, Wu CL, Chou SY, et al. Prevention of poststroke depression with milnacipran in patients with acute ischemic stroke:a double-blind randomized placebo-controlled trial. Int Clin Psychopharmacol, 2011, 26(5):263-267.
32.	Zhang LS, Hu XY, Yao LY, et al. Prophylactic effects of duloxetine on post-stroke depression symptoms:an open single-blind trial. Eur Neurol, 2013, 69(6):336-343.
33.	何萍, 孔岩, 许丽珍. 早期应用氟西汀预防脑卒中后抑郁的随机对照观察. 中国临床康复, 2004, 8(28):6016-6017.
34.	林海峰, 陈湛音, 陈逢俭, 等. 预防性抗抑郁治疗对脑卒中康复影响的临床研究. 海南医学, 2005, 16(8):48-49.
35.	李竞, 赫秋月, 韩漫夫. 早期应用氟西汀改善脑卒中患者神经功能缺损及预防脑卒中抑郁的近期效果. 中国临床康复, 2004, 8(7):1208-1209.
36.	宋磊, 藤军放. 氟西汀早期干预卒中后抑郁的临床研究. 中国实用神经疾病杂志, 2007, 10(3):13-15.
37.	施俊峰, 赵彦平. 早期使用氟西汀对防治脑卒中后抑郁的研究. 中华综合医学杂志, 2003, 5(4):33-34.
38.	吴勇平. 脑卒中后氟西汀干预对脑卒中后抑郁症发生率的影响. 中国乡村医药杂志, 2008, 15(6):19-20.
39.	温肇霞, 李晖. 脑卒中后预防性抗抑郁治疗对对神经功能康复的影响. 青岛大学医学院学报, 2006, 42(3):253-254.
40.	许晶, 王俊平, 刘晶. 抗抑郁剂在脑卒中患者中的预防性应用. 中国心理卫生杂志, 2006, 20(3):186-188.
41.	赵新慧, 温进哲, 袁芳. 草酸艾司西酞普兰预防卒中后抑郁的临床观察. 现代药物与临床, 2014, 29(3):269-272.
42.	周智林, 梁丽贞, 严永兴. 氟西汀对卒中后抑郁的预防性研究. 中国现代应用药学杂志, 2008, 25(3):262-264.
43.	孙鼎明, 袁勇贵, 张志珺. 卒中后抑郁诊断及量表的使用. 中国卒中杂志, 2007, 2(11):916-918.
44.	Flaster M, Sharma A, Rao M. Poststoke depression:a review emphasizing the role of prophylactic treatment and synergy with treatment for motor recovery. Top Stroke Rehabil, 2013, 20(2):139-150.
45.	Chen Y, Patel NC, Guo JJ, et al. Antidepressant prophylaxis for poststroke depression:a meta-analysis. Int Clin Psychopharm, 2007, 22(3):159-166.

1. Yan H, Fang M, Liu XY. Role of microRNAs in stroke and poststroke depression. Scientific World Journal, 2013, 2:459692.
2. Hackett ML, Anderson CS, House AO, et al. Management of depression after stroke:a systematic review of pharmacological therapies. Stroke, 2005, 36(5):1092-1097.
3. Poynter B, Hon MS, Diaz-Granados N, et al. Sex differences in the prevalence of post-stroke depression:a Systematic Review. Psychosomatics, 2009, 50(6):563-569.
4. Ayerbe L, Ayis S, Wolfe CD, et al. Natural history, predictors and outcomes of depression after stroke:systematic review and meta-analysis. Br J Psychiatry, 2013, 202(1):14-21.
5. Loubinoux I, Kronenberg G, Endres M, et al. Post-stroke depression:mechanisms, translation and therapy. J Cell Mol Med, 2012, 16(9):1961-1969.
6. Palomaki H, Kaste M, Berg A, et al. Prevention of poststroke depression:1 year rando-mised placebo controlled double blind trial of mianserin with 6 month follow up after therapy. J Neurol Neurosurg Psychiatry, 1999, 66(4):490-494.
7. Katherine L, Salter BA, Norine C, et al. Prevention of poststroke depression:does prophylatic pharmacotherapy work? J Stroke and Cerebrovasc Dis, 2013, 22(8):1243-1251.
8. 中华医学会全国第四届脑血管病学术会议编年会. 脑卒中患者临床神经功能缺损程度评分标准. 中华神经科杂志, 1996, 29:381-383.
9. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th edition. DSM-Ⅳ. Washington, DC. APA, 1994.
10. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 3th edition. DSM-Ⅲ-R. Washington, DC. APA, 1987.
11. 世界卫生组织, 主编. 刘平, 许又新, 译. 精神与行为障碍分类:研究用诊断标准. 北京:人民卫生出版社, 1995:138-139.
12. 中华医学会精神科学会, 南京医科大学脑科医院, 主编. 中国精神疾病分类方案与诊断标准. 南京:东南大学出版社, 1995:107.
13. 中华医学会精神科分会, 主编. 中国精神障碍分类与诊断标准, 第3版. 济南:山东科学技术出版社, 2001:147-149.
14. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry, 1960, 23:56-62.
15. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand, 1983, 67:361-370.
16. Montgomery SA, Asberg M. A new depression scale designed to be Sensitive to change. Br J Psychiatry, 1979, 134(6):382-389.
17. Higgins JPT, Green S. Assessing risk of bias in included studies:Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. The Cochrane Collaboration, 2011, Available at:www.cochranehandbook.org.
18. Almeida O, Wterreus A, Hankey G. Preventing depression after stroke:results from a randomized placebo-controlled trial. J Clin Psychiatry, 2006, 67(7):1104-1109.
19. Chollet F, TardyJ, Albucher J, et al. Fluoxetine for motor recovery after acute ischaemic stroke (FLAME):a randomized placebo-controlled trial. Lancet Neurol, 2011, 10(2):123-130.
20. Dam M, Tonin P, De Boni, A, et al. Effects of fluoxetine and maprotiline on functional recovery in poststroke hemiplegic patients undergoing rehabilitation therapy. Stroke, 1996, 27(7):1211-1214.
21. Charles G, Becky R, Jay C, et al. Methylphenidate in early poststroke recovery:A double-blind, placebo-controlled study. Arch Phys Med Rehabil, 1998, 79(9):1047-1050.
22. Yan K, Dong W, Liu C. Fluoxetine for poststroke depression a randomized placebo controlled clinical trial. NRR, 2007, 2(3):162-165.
23. Mikami K, Jorge R, Moser D, et al. Prevention of poststroke apathy using escitalopram or problem-solving therapy. Am J Geriatr Psychiatry, 2013, 21(9):855-862.
24. Narushima K, Kosier T, Robinson R. Preventing poststroke depression:A 12-week double-blind randomized treatment trial and 21-month follow-up. J Nerv and Ment Dis, 2002, 190(5):296-303.
25. Niedermaier N, Bohrer E, Schulte K, et al. Prevention and treatment of poststroke depression with mirtazapine in patients with acute stroke. J Clin Psychiatry, 2004, 65(12):1619-1623.
26. Raffaele R, Rampello L, Vecchio I, et al. Trazodone therapy of the post-stroke depression. Arch Gerontol Geriatr, 1996, 22(Suppl 1):217-220.
27. Rasmussen A, Poulsen M, Poulsen DL, et al. A double-blind, placebo-controlled study of sertraline in the prevention of depression in stroke patients. Psychosomatics, 2003, 44(3):216-221.
28. Robinson R, Susan K, Castillo C, et al. Nortriptyline versus fluoxetine in the treatment of depression and in short-term recovery after stroke:A placebo-controlled, double-blind study. Am J Psychiatry, 2000, 157(3):351-359.
29. Robinson RG, Jorge RE, Moser DJ, et al. Escitalopram and problem-solving therapy for prevention of poststroke depression. JAMA, 2008, 299(20):2391-2400.
30. Roh J, Lee K, Kim M, et al. Accelerated recovery from ischemic stroke with indeloxazine hydrochloride:results of a double-masked clinical study in Korea. Curr Ther Res, 1996, 57(8):632-642.
31. Tsai CS, Wu CL, Chou SY, et al. Prevention of poststroke depression with milnacipran in patients with acute ischemic stroke:a double-blind randomized placebo-controlled trial. Int Clin Psychopharmacol, 2011, 26(5):263-267.
32. Zhang LS, Hu XY, Yao LY, et al. Prophylactic effects of duloxetine on post-stroke depression symptoms:an open single-blind trial. Eur Neurol, 2013, 69(6):336-343.
33. 何萍, 孔岩, 许丽珍. 早期应用氟西汀预防脑卒中后抑郁的随机对照观察. 中国临床康复, 2004, 8(28):6016-6017.
34. 林海峰, 陈湛音, 陈逢俭, 等. 预防性抗抑郁治疗对脑卒中康复影响的临床研究. 海南医学, 2005, 16(8):48-49.
35. 李竞, 赫秋月, 韩漫夫. 早期应用氟西汀改善脑卒中患者神经功能缺损及预防脑卒中抑郁的近期效果. 中国临床康复, 2004, 8(7):1208-1209.
36. 宋磊, 藤军放. 氟西汀早期干预卒中后抑郁的临床研究. 中国实用神经疾病杂志, 2007, 10(3):13-15.
37. 施俊峰, 赵彦平. 早期使用氟西汀对防治脑卒中后抑郁的研究. 中华综合医学杂志, 2003, 5(4):33-34.
38. 吴勇平. 脑卒中后氟西汀干预对脑卒中后抑郁症发生率的影响. 中国乡村医药杂志, 2008, 15(6):19-20.
39. 温肇霞, 李晖. 脑卒中后预防性抗抑郁治疗对对神经功能康复的影响. 青岛大学医学院学报, 2006, 42(3):253-254.
40. 许晶, 王俊平, 刘晶. 抗抑郁剂在脑卒中患者中的预防性应用. 中国心理卫生杂志, 2006, 20(3):186-188.
41. 赵新慧, 温进哲, 袁芳. 草酸艾司西酞普兰预防卒中后抑郁的临床观察. 现代药物与临床, 2014, 29(3):269-272.
42. 周智林, 梁丽贞, 严永兴. 氟西汀对卒中后抑郁的预防性研究. 中国现代应用药学杂志, 2008, 25(3):262-264.
43. 孙鼎明, 袁勇贵, 张志珺. 卒中后抑郁诊断及量表的使用. 中国卒中杂志, 2007, 2(11):916-918.
44. Flaster M, Sharma A, Rao M. Poststoke depression:a review emphasizing the role of prophylactic treatment and synergy with treatment for motor recovery. Top Stroke Rehabil, 2013, 20(2):139-150.
45. Chen Y, Patel NC, Guo JJ, et al. Antidepressant prophylaxis for poststroke depression:a meta-analysis. Int Clin Psychopharm, 2007, 22(3):159-166.

Previous Article
Relationship between Birth Number and Breast Cancer Risk of Chinese Female: A Meta-analysis
Next Article
Effectiveness of Scalp Acupuncture for Ischemic Stroke: A Meta-analysis

Chinese Journal of Evidence-Based Medicine

Efficacy of Antidepressants in Preventing Poststroke Depression: A Meta-analysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content