Antidepressant drug treatment for poststroke depression: retrospective study

The records of 60 patients evaluated psychiatrically for major depression after stroke were reviewed retrospectively. Forty-two patients were treated with one of several "cyclic" antidepressant drugs, and 18 received no drug treatment. Objective ratings, based on current standard criteria for "major depression" (DSM-III), were used to establish degree of depression at initial evaluation and within six weeks after the start of treatment. Overall, improvement in depression was no greater in treated than in untreated patients. However, a subgroup (40%) of drug-treated patients was identified with a substantial (greater than or equal to 40%) improvement in depression ratings. Only three (17%) untreated patients showed a comparable improvement within a similar time period. Eighteen (43%) of the drug-treated patients experienced minor side effects (especially mild sedation), but only three (7%) experienced major side effects that required cessation of treatment. The degree of initial depression was not correlated with the degree of motor or functional disability among patients. These results suggest that antidepressants may constitute safe and effective treatment for some patients with poststroke depression, and further studies of the pathophysiology and treatment of this disorder are indicated.