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：

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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.	中華醫學會全國第四屆腦血管病學術會議編年會. 腦卒中患者臨床神經功能缺損程度評分標準. 中華神經科雜志, 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.	世界衛生組織, 主編. 劉平, 許又新, 譯. 精神與行為障礙分類:研究用診斷標準. 北京:人民衛生出版社, 1995:138-139.
12.	中華醫學會精神科學會, 南京醫科大學腦科醫院, 主編. 中國精神疾病分類方案與診斷標準. 南京:東南大學出版社, 1995:107.
13.	中華醫學會精神科分會, 主編. 中國精神障礙分類與診斷標準, 第3版. 濟南:山東科學技術出版社, 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, 孔巖, 許麗珍. 早期應用氟西汀預防腦卒中后抑郁的隨機對照觀察. 中國臨床康復, 2004, 8(28):6016-6017.
34.	林海峰, 陳湛音, 陳逢儉, 等. 預防性抗抑郁治療對腦卒中康復影響的臨床研究. 海南醫學, 2005, 16(8):48-49.
35.	李競, 赫秋月, 韓漫夫. 早期應用氟西汀改善腦卒中患者神經功能缺損及預防腦卒中抑郁的近期效果. 中國臨床康復, 2004, 8(7):1208-1209.
36.	宋磊, 藤軍放. 氟西汀早期干預卒中后抑郁的臨床研究. 中國實用神經疾病雜志, 2007, 10(3):13-15.
37.	施俊峰, 趙彥平. 早期使用氟西汀對防治腦卒中后抑郁的研究. 中華綜合醫學雜志, 2003, 5(4):33-34.
38.	吳勇平. 腦卒中后氟西汀干預對腦卒中后抑郁癥發生率的影響. 中國鄉村醫藥雜志, 2008, 15(6):19-20.
39.	溫肇霞, 李暉. 腦卒中后預防性抗抑郁治療對對神經功能康復的影響. 青島大學醫學院學報, 2006, 42(3):253-254.
40.	許晶, 王俊平, 劉晶. 抗抑郁劑在腦卒中患者中的預防性應用. 中國心理衛生雜志, 2006, 20(3):186-188.
41.	趙新慧, 溫進哲, 袁芳. 草酸艾司西酞普蘭預防卒中后抑郁的臨床觀察. 現代藥物與臨床, 2014, 29(3):269-272.
42.	周智林, 梁麗貞, 嚴永興. 氟西汀對卒中后抑郁的預防性研究. 中國現代應用藥學雜志, 2008, 25(3):262-264.
43.	孫鼎明, 袁勇貴, 張志珺. 卒中后抑郁診斷及量表的使用. 中國卒中雜志, 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. 中華醫學會全國第四屆腦血管病學術會議編年會. 腦卒中患者臨床神經功能缺損程度評分標準. 中華神經科雜志, 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. 世界衛生組織, 主編. 劉平, 許又新, 譯. 精神與行為障礙分類:研究用診斷標準. 北京:人民衛生出版社, 1995:138-139.
12. 中華醫學會精神科學會, 南京醫科大學腦科醫院, 主編. 中國精神疾病分類方案與診斷標準. 南京:東南大學出版社, 1995:107.
13. 中華醫學會精神科分會, 主編. 中國精神障礙分類與診斷標準, 第3版. 濟南:山東科學技術出版社, 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, 孔巖, 許麗珍. 早期應用氟西汀預防腦卒中后抑郁的隨機對照觀察. 中國臨床康復, 2004, 8(28):6016-6017.
34. 林海峰, 陳湛音, 陳逢儉, 等. 預防性抗抑郁治療對腦卒中康復影響的臨床研究. 海南醫學, 2005, 16(8):48-49.
35. 李競, 赫秋月, 韓漫夫. 早期應用氟西汀改善腦卒中患者神經功能缺損及預防腦卒中抑郁的近期效果. 中國臨床康復, 2004, 8(7):1208-1209.
36. 宋磊, 藤軍放. 氟西汀早期干預卒中后抑郁的臨床研究. 中國實用神經疾病雜志, 2007, 10(3):13-15.
37. 施俊峰, 趙彥平. 早期使用氟西汀對防治腦卒中后抑郁的研究. 中華綜合醫學雜志, 2003, 5(4):33-34.
38. 吳勇平. 腦卒中后氟西汀干預對腦卒中后抑郁癥發生率的影響. 中國鄉村醫藥雜志, 2008, 15(6):19-20.
39. 溫肇霞, 李暉. 腦卒中后預防性抗抑郁治療對對神經功能康復的影響. 青島大學醫學院學報, 2006, 42(3):253-254.
40. 許晶, 王俊平, 劉晶. 抗抑郁劑在腦卒中患者中的預防性應用. 中國心理衛生雜志, 2006, 20(3):186-188.
41. 趙新慧, 溫進哲, 袁芳. 草酸艾司西酞普蘭預防卒中后抑郁的臨床觀察. 現代藥物與臨床, 2014, 29(3):269-272.
42. 周智林, 梁麗貞, 嚴永興. 氟西汀對卒中后抑郁的預防性研究. 中國現代應用藥學雜志, 2008, 25(3):262-264.
43. 孫鼎明, 袁勇貴, 張志珺. 卒中后抑郁診斷及量表的使用. 中國卒中雜志, 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.

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