Doxepin (SMD -1.93), paroxetine (SMD -1.39), and nortriptyline (SMD -1.25) were significantly more effective than placebo in reducing overall depressive symptoms in post-stroke depression.
Meta-Analysis (n=949)
Do antidepressant treatments improve overall depressive symptoms in patients with post-stroke depression?
While doxepin, paroxetine, and nortriptyline demonstrated significant efficacy over placebo, there is currently insufficient evidence to definitively select a preferred antidepressant for treating post-stroke depression.
Effect estimate: SMD -1.93 (doxepin), -1.39 (paroxetine), -1.25 (nortriptyline) (95% CI -3.56 to -0.29, -2.59 to -0.21, -2.46 to -0.04)
The aim of this study was to investigate the efficacy, acceptability, and tolerability of antidepressants in treating post-stroke depression (PSD) by performing a network meta-analysis of randomized controlled trials of the current literature. Eligible studies were retrieved from online databases, and relevant data were extracted. The primary outcome was efficacy as measured by the mean change in overall depressive symptoms. Secondary outcomes included discontinued treatment for any reason and specifically due to adverse events. Fourteen trials were eligible, which included 949 participants and 9 antidepressant treatments. Few significant differences were found for all outcomes. For the primary outcome, doxepin, paroxetine, and nortriptyline were significantly more effective than a placebo standardized mean differences: -1.93 (95%CI=-3.56 to -0.29), -1.39 (95%CI=-2.59 to -0.21), and -1.25 (95%CI=-2.46 to -0.04), respectively. Insufficient evidence exists to select a preferred antidepressant for treating patients with post-stroke depression, and our study provides little evidence that paroxetine may be the potential choice when starting treatment for PSD. Future studies with paroxetine and larger sample sizes, multiple medical centers, and sufficient intervention durations is needed for improving the current evidence.
Qin et al. (Mon,) conducted a meta-analysis in Post-stroke depression (n=949). Antidepressants (9 treatments including doxepin, paroxetine, and nortriptyline) vs. Placebo was evaluated on Efficacy as measured by the mean change in overall depressive symptoms (SMD -1.93 (doxepin), -1.39 (paroxetine), -1.25 (nortriptyline), 95% CI -3.56 to -0.29, -2.59 to -0.21, -2.46 to -0.04). Doxepin (SMD -1.93), paroxetine (SMD -1.39), and nortriptyline (SMD -1.25) were significantly more effective than placebo in reducing overall depressive symptoms in post-stroke depression.