Effect of sertraline in the treatment and prevention of poststroke depression

BACKGROUND: Morbidity of poststroke depression (PSD) remains high worldwide. Additionally, PSD causes multiple sequelae. Although sertraline has been reported to be effective in treating PSD, many studies remain inconsistent. METHODS: PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials, Clinical trials. gov, Wan fang Data (Chinese), VIP (Chinese), and CNKI (Chinese) were retrieved from inception to April 2017. Randomized controlled trials (RCTs) and self-controlled trials (SCTs) were recruited, which met the inclusion criteria in our study. The depression rating scores, the incidence of PSD, activities of daily living (ADL), neurological impairment scores, and adverse effects were assessed. RESULTS: Around 11 studies were recruited in our work, including 1258 participants. For trials enrolled, the results were depicted: the reduction of depression rating scores was significant in sertraline groups (WMD -6.38; 95% CI -8.63 to -4.14; P < .00001); the incidence of PSD was significantly lower in sertraline groups (RR 0.48; 95%CI 0.35-0.67; P < .0001); there was obvious improvement of ADL (WMD 11.48; 95% CI 4.18-18.78; P = .002 <0.05) and neurological impairment (WMD -3.44; 95% CI -6.66 to -0.21; P = .04 <0.05); no significant difference between sertraline and control groups in the morbidity of adverse events (RR 0.94; 95% CI 0.83-1.06; P = .33 >0.05). However, in sensitivity analyses, the conclusions of the reduction of depression rating scores and the improvement of ADL were altered. CONCLUSIONS: The study suggests that sertraline has a potentially protective role compared with control groups and demonstrates sertraline is safe. However, the reduction of depression rating scores and the improvement of ADL should be considered carefully.