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September 2007

Antidepressants Can Help Prevent Depression after Stroke
Antidepressant drugs may provide relief for many patients suffering from depression following stroke.

Prazosin for PTSD Nightmares
Adjunctive treatment with the α1-blocker prazosin (Minipress and others) reduces trauma nightmares and sleep disturbance in patients with posttraumatic stress disorder.

Treating Bipolar Depression
Antidepressants add little benefit in treating bipolar depression, but the risk of inducing mania appears small.

Are SSRIs Teratogens?
There is a small risk of congenital malformations with fetal exposure to selective serotonin reuptake inhibitors, particularly paroxetine (Paxil and others), during the first trimester.

In Brief
Benefits of Antidepressants versus Suicide Risk; Rivastigmine Does Not Slow Progression to Alzheimer's Disease

Antidepressants Can Help Prevent Depression after Stroke

September 2007

After a stroke, an estimated 20% to 65% of patients may experience depression. When depression complicates recovery from stroke, response to rehabilitation therapy and quality of life decrease, while mortality risk and caregivers' burden rise. To assess the potential benefits of antidepressant prophylaxis following stroke, Chen and associates conducted a meta-analysis.1

The authors used data from 10 randomized, placebo-controlled clinical trials. Antidepressants in these studies included selective serotonin reuptake inhibitors (SSRIs), tricyclics, and other classes, with doses in the usual therapeutic range. New cases of poststroke depression occurred in 29.17% of the control group versus 12.54% among patients taking antidepressants. Both SSRI and tricyclic antidepressants showed a significant reduction in the incidence of poststroke depression. The benefit was more obvious following ischemic stroke.

Folstein and others have observed that high homocysteine levels are associated with cerebrovascular disease and hypothesize that elevated homocysteine levels might contribute to the associated depression risk.2 If borne out by prospective studies, this theory could pave the way for new interventions to prevent or treat poststroke depression.

Many questions remain about potential differences among antidepressants, timing of prophylaxis after a stroke, dose-response relationships, mechanism of action, and more. But it does seem obvious that depression can be a substantial problem following stroke, and that for many patients, antidepressant drugs may provide relief.

1Chen Y, Patel NC, Guo JJ, Zhan S: Antidepressant prophylaxis for poststroke depression: A meta-analysis. Int Clin Psychopharmacol 2007;22:159-166.

2Folstein M, Liu T, Peter I, Buel J, Arsenault L, Scott T, Qiu WW: The homocysteine hypothesis of depression. Am J Psychiatry 2007;164:861-867.