Antidepressants May Prevent Depression After Stroke

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During 12 months of therapy, Robinson's group found that patients who received a placebo were 4.5 times more likely to become depressed, compared with patients who received Lexapro, and 2.2 times more likely to become depressed than patients in the therapy program.

Further analysis showed that Lexapro was significantly better than a placebo in preventing depression, while problem-solving therapy was not significantly better.

"The clinical implications of our findings are that patients who are given escitalopram or problem-solving therapy following acute stroke may be spared depression, and perhaps its adverse consequences," the researchers concluded.

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One expert thinks that treating depression before it begins may be a viable option for some patients after stroke.

"Depression is a huge problem after stroke," said Dr. Argye Hillis, an associate professor of neurology at Johns Hopkins University. "This is an important study that might convince people to either start patients on preventive therapy or at least monitor very closely for depression and then start them on therapy."

Hillis noted that whether prevention is better than acute treatment isn't clear. "Based on this study, giving patients the option of preventive therapy may be the best choice for some patients," she said.

"One thing that has not been evaluated, and might be even more effective, is the combination of problem-solving therapy and medication," Hillis added.

Another expert isn't sure the results of this trial mean that all patients need to be treated for depression before it develops.

"This is a small study, and I think we need to be cautious before changing practice based on this study alone," said Dr. Eric Smith, associate director of Acute Stroke Services at Massachusetts General Hospital and Harvard Medical School.

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