Efficacy and tolerability of pharmacotherapy for post-stroke depression: a network meta-analysis

// Linghui Deng 1, * , Shi Qiu 2, * , Yan Yang 3, * , Lu Wang 1, * , Yuxiao Li 1 , Jing Lin 1 , Qiang Wei 2 , Lu Yang 2 , Deren Wang 1 and Ming Liu 1 1 Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China 2 Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China 3 Kidney Research Institute, Division of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan, China * These authors contributed equally to this work Correspondence to: Ming Liu, email: wyplmh@hotmail.com Deren Wang, email: wdr0128@qq.com Keywords: post-stroke depression; pharmacotherapy; network meta-analysis; Hamilton depression scale Received: August 21, 2017      Accepted: November 13, 2017      Epub: January 03, 2018      Published: May 04, 2018 ABSTRACT Background: Post-stroke depression (PSD) occurs in approximately one third of stroke survivors, leading to great disability and mortality. As there is no consensus on the optimal pharmacological treatment for PSD, we aimed to evaluate the relative efficacy and tolerability of the available pharmacological interventions. Materials and Methods: We did a network meta-analysis to incorporate evidence from relevant trials providing direct and indirect comparisons. We searched PubMed, the Cochrane Library Central Register of Controlled Trials, Embase and the reference lists of relevant articles up to March, 2017 for randomized controlled trials (RCTs), for different pharmacotherapies of PSD. For efficacy analysis, the primary outcome was the mean change in Hamilton Depression Scale (HAMD) score between baseline and endpoint. For tolerability analysis, the outcome was presented by the discontinuation for any reason. This study is registered with PROSPERO, number CRD42016049049. Results: From a total of 869 citations, 15 RCTs with 876 participants were included. 13 drugs were considered. For efficacy, paroxetine ranked the best for HAMD reduction, followed by imipramine, reboxetine, nortriptyline, citalopram and fluoxetine at the end of treatment. However, duloxetine ranked the best at 4-week and 8-week duration for HAMD reduction. For tolerability, paroxetine ranked the best but there is no significant result between any comparisons. Conclusions: Paroxetine is probably the best option to consider for patients with PSD. To get a quicker relief of depression, duloxetine might be useful for its rapid onset of antidepressant action. The tolerability was comparable among all the antidepressants. But more high-quality RCTs are needed.