Escitalopram Improves Stroke Recovery Beyond 3 Months of Treatment

By Chris Berrie

COPENHAGEN, Denmark -- May 31, 2016 -- The antidepressant escitalopram significantly improves recovery for patients who have had a stroke, with benefits occurring regardless of stroke subtype or baseline depression, and continuing beyond 3 months of treatment, according to results of an open-label study presented at the 2nd Congress of the European Academy of Neurology (EAN).

“Depression is very frequently the result of a stroke,” stated coauthor Aurel Simion, MD, PhD, Municipal Clinical Hospital, University of Oradea, Oradea, Romania, speaking here on May 30. Several studies have shown benefits for antidepressant treatment after stroke, he added.

Dr. Simion and colleagues randomised patients who had had an ischaemic stroke to receive secondary preventive treatment with placebo (n = 46; mean age, 69.2 years) or with escitalopram 19 mg/day (n = 43; mean age, 66.3 years), for 3 months, with follow-up to 12 months. Analyses included various stroke and depression rating scales examined at end of treatment and at 12 months.

Stroke subtypes were equally balanced in the total patient population: thrombotic (33%), lacunar (31%), and cardioembolic (36%).

The National Institutes of Health stroke Severity scale (NIHSS) scores showed trends and some significance between placebo and escitalopram according to thrombotic, lacunar and cardioembolic stroke at 3 months (4.57 vs 2.80, P = .194; 4.00 vs 2.31, P = .141; 3.65 vs 1.47, P = .048; respectively), with all showing significant benefits for active treatment at 12 months (6.21 vs 1.00, P< .001; 5.53 vs 0.46, P< .0001; 2.71 vs 0.67, P = .029). These results were paralleled in the Barthel Index stroke severity rating.

Results were similar, respectively, for depression indices of Hamilton Depression Scale (HAM-D17) at 3 months between placebo and escitalopram according to thrombotic, lacunar and cardioembolic stroke (13.86 vs 11.53, P = .24; 15.00 vs 9.23, P = .001; 10.88 vs 7.67, P = .021) and at 12 months (16.93 vs 7.00, P< .001; 16.67 vs 6.08, P< .001; 10.76 vs 5.47, P = .003). Results from the Beck Depression Inventory (BDI ) paralleled those results between placebo and escitalopram according to thrombotic, lacunar and cardioembolic stroke at 3 months (15.64 vs 14.07, P = .499; 20.67 vs 12.92, P = .001; 16.24 vs 11.93, P = .025) and 12 months (21.43 vs 7.93, P< .001; 24.60 vs 8.54, P< .001; 16.24 vs 8.40, P = .003).

Similar results were demonstrated for improvements in Activities of Daily Living between placebo and escitalopram according to thrombotic, lacunar and cardioembolic stroke at 3 months (4.00 vs 5.13, P = .021; 3.67 vs 5.00, P = .046; 4.82 vs 5.53, P = .154; respectively) and at 12 months (3.36 vs 5.87, P< .001; 2.73 vs 5.85, P< .001; 4.76 vs 5.87, P = .014).

Finally, the investigators observed reductions in stroke recurrence for active treatment according to thrombotic, lacunar and cardioembolic stroke at 3 months (21.4% vs 6.7%; 26.7% vs 7.7%; 23.5% vs 0.0%) and at 12 months (28.6% vs 0.0%; 53.3% vs 0.0%; 17.6% vs 6.7%).

The researchers acknowledge that the mechanism by which antidepressant therapy achieves these benefits is not yet fully understood, and is, therefore, controversial. Regardless, “it is a good measure to treat these patients with serotonin reuptake inhibitor antidepressants,” Dr Simion concluded.

Baseline clinical characteristics were similar across the placebo and escitalopram arms for overall mean NIHSS scores (8.52 vs 8.56) and for depression indices, including overall mean HAM-D17 scores (12.3 vs 13.5) and BDI scores (15.5 vs 17.9).

[Presentation title: Improved Post-Ischaemic Stroke Recovery Over 1 Year With Escitalopram for 3 Months. Abstract P31030]
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