This is not the most recent version of the article. View current version (8 OCT 2008)
Interventions for treating depression after stroke
Editorial Group: Cochrane Stroke Group
Published Online: 19 JUL 2004
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Hackett ML, Anderson CS, House AO. Interventions for treating depression after stroke. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD003437. DOI: 10.1002/14651858.CD003437.pub2.
- Publication Status: Unchanged
- Published Online: 19 JUL 2004
This is not the most recent version of the article. View current version (08 OCT 2008)
Depressive and anxiety disorders following stroke are often undiagnosed or inadequately treated. This may reflect difficulties with the diagnosis of abnormal mood among older people with stroke-related disability, but may also reflect uncertainty about the effectiveness of such therapies in this setting.
To determine whether pharmacological, psychological, or electroconvulsive treatment (ECT) of depression in patients with stroke can improve outcome.
The Cochrane Stroke Group Trials Register (last searched June 2003). The Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2002), MEDLINE (1966 to September 2002), EMBASE (1980 to September 2002), CINAHL (1982 to September 2002), PsychINFO (1967 to September 2002), Applied Science and Technology Plus (1986 to September 2002), Arts and Humanities Index (1991 to September 2002), Biological Abstracts (1969 to September 2002), General Science Plus (1994 to September 2002), Science Citation Index (1992 to September 2002), Social Sciences Citation Index (1991 to September 2002), and Sociofile (1974 to September 2002). Reference lists from relevant articles and textbooks were searched, and authors of known studies and pharmaceutical companies who manufacture psychotropic medications were contacted.
Randomised and quasi-randomised controlled trials comparing different types of pharmaceutical agents with placebo, or various forms of psychotherapy with standard care (or attention control), in patients with recent, clinically diagnosed, acute stroke, where treatment was explicitly intended of treat depression.
Data collection and analysis
Primary analyses focussed on the prevalence of diagnosable depressive disorder at the end of treatment. Secondary outcomes included depression or mood scores on standard scales, disability or physical function, death, recurrent stroke, and adverse effects. We did not pool the data for summary scores. We performed meta-analysis for only some binary endpoints and data on adverse events.
Nine trials, with 780 participants, were included in the review. Data were available for seven trials of pharmaceutical agents, and two trials of psychotherapy. There were no trials of ECT. The analyses were complicated by the lack of standardised diagnostic and outcome criteria, and differing analytic methods. There was no strong evidence of benefit of either pharmacotherapy or psychotherapy in terms of a complete remission of depression following stroke. There was evidence of a reduction (improvement) in scores on depression rating scales, and an increase in the proportion of participants with anxiety at the end of follow up.
This review found no evidence to support the routine use of pharmacotherapeutic or psychotherapeutic treatment for depression after stroke. More research is required before recommendations can be made about the most appropriate management of depression following stroke.
Plain language summary
Antidepressants may reduce, but not necessarily abolish, depression after stroke.
Depression is common after stroke and may be treated with antidepressant medication or psychological therapy. This review found that antidepressants appeared to lead to a reduction in scores on mood rating scales, but not to a reduction in the frequency of clinically diagnosable depression. In one study, anxiety increased. There was insufficient evidence to establish the effectiveness or disadvantages of antidepressants, especially in the longer courses (four to six months) that are usually prescribed in clinical practice. We found no evidence for the benefit of psychotherapy in two small trials.