Advances in antidepressants for treating post-stroke depression

ABSTRACT

Introduction: Post-stroke depression (PSD) is a common and serious complication after stroke, occurring in nearly one third of stroke survivors, and affecting mortality rate, functional outcome, rehabilitation results and quality of life. However, in the common clinical practice only a minority of patients are properly treated. A relatively small number of scientific reports are available on clinical usefulness and safety of antidepressants (ADs) in PSD.

Areas covered: This report provides an updated review about pharmacological state of art of PSD, including efficacy and safety of different drugs and their role on prevention, treatment and functional outcome.

Expert opinion: Even if currently an antidepressant treatment can improve depressive symptoms, neither the optimal drug nor the optimal lengths of treatment, have been identified. Serotonergic drugs are preferable because of their better safety profile, but in the recent years there has been an important debate on possible association between selective serotonin reuptake inhibitor use and increased mortality. Another issue is the potential role of ADs for improving functional recovery. Newer ADs have interesting properties, in particular vortioxetine, due to its properties of enhancing cognitive functions, but further research is needed to clarify its/their role in treatment of PSD.

KEYWORDS:

• Depression
• stroke
• antidepressants
• functional outcome
• rehabilitation

Article highlights

• PSD is a negative, but modifiable risk factors both ‘quoad vitam’ and ‘quoad valetudinem’.

• ADs are beneficial in improving depressive symptoms, but evidence for the choice of optimal drug and length of treatment are inconclusive. The choice of the drug must be based on guidelines and clinical factors.

• There is a wide debate of safety of ADs, in particular if a treatment with SSRIs is associated with high risk of mortality

• Although some data are available about usefulness of ADs for preventing depression and for promoting functional recovery, further studies are necessary to elucidate their mechanisms and consolidate this evidence.

• Vortioxetine might become an important option for treatment PSD.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.