Efficacy and safety of escitalopram in preventing post-stroke depression: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Sijie , ZHANG Jun , LIU Ruming , LI Qian , HUANG Hua , WANG Jingjing ,  YAO Qin

Department of Clinical Pharmacy, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, P.R.China;

Corresponding?author：

YAO Qin, Email: 2335799@qq.com

Keywords：

Escitalopram; Post-stroke depression; Prevention; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.201905090

Video：

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Objectives To systematically review the efficacy and safety of escitalopram in the prevention of post-stroke depression (PSD).Methods PubMed, The Cochrane Library, CBM, WanFang Data, VIP and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) on escitalopram in preventing PSD from inception to March 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.Results A total of 6 RCTs involving 891 patients were included. The results of meta-analysis showed that: compared with the control group, the escitalopram group could reduce the incidence of PSD (RR=0.55, 95%CI 0.31 to 0.98, P=0.04). In addition, there was no statistical difference between escitalopram group and control group in rate of adverse events (P≥0.05).Conclusions Current evidence shows that escitalopram can reduce the incidence of PSD without increasing the incidence of adverse reactions. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

Citation： WANG Sijie, ZHANG Jun, LIU Ruming, LI Qian, HUANG Hua, WANG Jingjing, YAO Qin. Efficacy and safety of escitalopram in preventing post-stroke depression: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2019, 19(10): 1181-1186. doi: 10.7507/1672-2531.201905090 Copy

1.	王少石, 周新雨, 朱春燕. 卒中后抑郁臨床實踐的中國專家共識. 中國卒中雜志, 2016, 11(8): 685-693.
2.	Hackett ML, Pickles K. Part I: frequency of depression after stroke: an updated systematic review and meta-analysis of observational studies. Int J Stroke, 2014, 9(8): 1017-1025.
3.	Ayerbe L, Ayis S, Wolfe CD, et al. Natural history, predictors and outcomes of depression after stroke: systematic review and meta-analysis. Br J Psychiatry, 2013, 202(1): 14-21.
4.	Xu JH, Jiang P. Efficacy of escitalopram oxalate for patients with post-stroke depression. Medicine (Baltimore), 2018, 97(14): e0219.
5.	腦卒中患者臨床神經功能缺損程度評分標準(1995). 中華神經科雜志, 1996, (6): 62-64.
6.	American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th edition, DSM-Ⅳ. Washington, DC: APA, 1994.
7.	American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 3th edition, DSM-Ⅲ-R. Washington, DC: APA, 1987.
8.	世界衛生組織. 精神與行為障礙分類: 研究用診斷標準. 劉平, 許又新(譯). 北京: 人民衛生出版社, 1995: 138-139.
9.	中華醫學會精神科學會, 南京醫科大學腦科醫院. 中國精神疾病分類方案與診斷標準. 南京: 東南大學出版社, 1995: 107.
10.	中華醫學會精神病學分會. 中國精神障礙分類與診斷標準第三版(精神障礙分類). 中華精神科雜志, 2001, 34(3): 184-188.
11.	Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry, 1960, 23: 56-62.
12.	Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand, 1983, 67(6): 361-370.
13.	Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry, 1979, 134(6): 382-389.
14.	Higgins JPT, Green S. Assessing risk of bias in included studies: Cochrane handbook for systematic reviews of interventions 5.1.0. The Cochrane Collaboration, 2011, Available at: www.cochranehandbook.org.
15.	Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med, 2002, 21(11): 1539-1558.
16.	Jorge RE, Acion L, Moser D, et al. Escitalopram and enhancement of cognitive recovery following stroke. Arch Gen Psychiatry, 2010, 67(2): 187-196.
17.	Mikami K, Jorge RE, Moser DJ, et al. Prevention of poststroke apathy using escitalopram or problem-solving therapy. Am J Geriatr Psychiatry, 2013, 21(9): 855-862.
18.	Robinson RG, Jorge RE, Long J. Prevention of poststroke mortality using problem-solving therapy or escitalopram. Am J Geriatr Psychiatry, 2017, 25(5): 512-519.
19.	Robinson RG, Jorge RE, Moser DJ, et al. Escitalopram and problem-solving therapy for prevention of poststroke depression: a randomized controlled trial. JAMA, 2008, 299(20): 2391-2400.
20.	Kim JS, Lee EJ, Chang DI, et al. Efficacy of early administration of escitalopram on depressive and emotional symptoms and neurological dysfunction after stroke: a multicentre, double-blind, randomised, placebo-controlled study. Lancet Psychiatry, 2017, 4(1): 33-41.
21.	趙新慧, 溫進哲, 袁芳. 草酸艾司西酞普蘭預防卒中后抑郁的臨床觀察. 現代藥物與臨床, 2014, 29(3): 269-272.
22.	Sánchez C, B?ges? KP, Ebert B, et al. Escitalopram versus citalopram: the surprising role of the R-enantiomer. Psychopharmacology (Berl), 2004, 174(2): 163-176.
23.	Caeiro L, Ferro JM, Pinho E Melo T, et al. Post-stroke apathy: an exploratory longitudinal study. Cerebrovasc Dis, 2013, 35(6): 507-513.
24.	費鵬鴿, 李麗平, 宋景貴. 氟西汀治療腦卒中后抑郁療效的Meta分析. 中國實用神經疾病雜志, 2016, 19(11): 1-3.
25.	王娟, 何超, 余雨. 舍曲林治療卒中后抑郁的Meta分析. 重慶醫學, 2016, 45(22): 3100-3103, 3111.
26.	陽中明. 米氮平治療腦卒中后抑郁對照研究的Meta分析. 臨床合理用藥雜志, 2013, 6(12): 3-4.
27.	韓琳, 陳寧, 何俐. 抗抑郁藥預防卒中后抑郁有效性的Meta分析. 中國循證醫學雜志, 2015, 15(10): 1153-1160.
28.	House A. Escitalopram may improve some cognitive functions after stroke in non-depressed patients. Evid Based Ment Health, 2010, 13(3): 81.
29.	Gu SC, Wang CD. Early selective serotonin reuptake inhibitors for recovery after stroke: a meta-analysis and trial sequential analysis. J Stroke Cerebrovasc Dis, 2018, 27(5): 1178-1189.
30.	Hackett ML, Anderson CS, House AO, et al. Management of depression after stroke: a systematic review of pharmacological therapies. Stroke, 2005, 36(5): 1092-1097.
31.	Palom?ki H, Kaste M, Berg A, et al. Prevention of poststroke depression: 1 year randomised placebo controlled double blind trial of mianserin with 6 month follow up after therapy. J Neurol Neurosurg Psychiatry, 1999, 66(4): 490-494.
32.	Narushima K, Kosier JT, Robinson RG. Preventing poststroke depression: a 12-week double-blind randomized treatment trial and 21-month follow-up. J Nerv Ment Dis, 2002, 190(5): 296-303.
33.	王同顯, 于瑞寶, 喬顯森. 選擇性血清素再攝取抑制劑類抗抑郁藥物相關出血風險. 中國輸血雜志, 2014, 27(4): 448-451.
34.	Quinn GR, Singer DE, Chang Y, et al. Effect of selective serotonin reuptake inhibitors on bleeding risk in patients with atrial fibrillation taking warfarin. Am J Cardiol, 2014, 114(4): 583-586.
35.	Sayal KS, Duncan-McConnell DA, McConnell HW, et al. Psychotropic interactions with warfarin. Acta Psychiatr Scand, 2000, 102(4): 250-255.

1. 王少石, 周新雨, 朱春燕. 卒中后抑郁臨床實踐的中國專家共識. 中國卒中雜志, 2016, 11(8): 685-693.
2. Hackett ML, Pickles K. Part I: frequency of depression after stroke: an updated systematic review and meta-analysis of observational studies. Int J Stroke, 2014, 9(8): 1017-1025.
3. Ayerbe L, Ayis S, Wolfe CD, et al. Natural history, predictors and outcomes of depression after stroke: systematic review and meta-analysis. Br J Psychiatry, 2013, 202(1): 14-21.
4. Xu JH, Jiang P. Efficacy of escitalopram oxalate for patients with post-stroke depression. Medicine (Baltimore), 2018, 97(14): e0219.
5. 腦卒中患者臨床神經功能缺損程度評分標準(1995). 中華神經科雜志, 1996, (6): 62-64.
6. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th edition, DSM-Ⅳ. Washington, DC: APA, 1994.
7. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 3th edition, DSM-Ⅲ-R. Washington, DC: APA, 1987.
8. 世界衛生組織. 精神與行為障礙分類: 研究用診斷標準. 劉平, 許又新(譯). 北京: 人民衛生出版社, 1995: 138-139.
9. 中華醫學會精神科學會, 南京醫科大學腦科醫院. 中國精神疾病分類方案與診斷標準. 南京: 東南大學出版社, 1995: 107.
10. 中華醫學會精神病學分會. 中國精神障礙分類與診斷標準第三版(精神障礙分類). 中華精神科雜志, 2001, 34(3): 184-188.
11. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry, 1960, 23: 56-62.
12. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand, 1983, 67(6): 361-370.
13. Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry, 1979, 134(6): 382-389.
14. Higgins JPT, Green S. Assessing risk of bias in included studies: Cochrane handbook for systematic reviews of interventions 5.1.0. The Cochrane Collaboration, 2011, Available at: www.cochranehandbook.org.
15. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med, 2002, 21(11): 1539-1558.
16. Jorge RE, Acion L, Moser D, et al. Escitalopram and enhancement of cognitive recovery following stroke. Arch Gen Psychiatry, 2010, 67(2): 187-196.
17. Mikami K, Jorge RE, Moser DJ, et al. Prevention of poststroke apathy using escitalopram or problem-solving therapy. Am J Geriatr Psychiatry, 2013, 21(9): 855-862.
18. Robinson RG, Jorge RE, Long J. Prevention of poststroke mortality using problem-solving therapy or escitalopram. Am J Geriatr Psychiatry, 2017, 25(5): 512-519.
19. Robinson RG, Jorge RE, Moser DJ, et al. Escitalopram and problem-solving therapy for prevention of poststroke depression: a randomized controlled trial. JAMA, 2008, 299(20): 2391-2400.
20. Kim JS, Lee EJ, Chang DI, et al. Efficacy of early administration of escitalopram on depressive and emotional symptoms and neurological dysfunction after stroke: a multicentre, double-blind, randomised, placebo-controlled study. Lancet Psychiatry, 2017, 4(1): 33-41.
21. 趙新慧, 溫進哲, 袁芳. 草酸艾司西酞普蘭預防卒中后抑郁的臨床觀察. 現代藥物與臨床, 2014, 29(3): 269-272.
22. Sánchez C, B?ges? KP, Ebert B, et al. Escitalopram versus citalopram: the surprising role of the R-enantiomer. Psychopharmacology (Berl), 2004, 174(2): 163-176.
23. Caeiro L, Ferro JM, Pinho E Melo T, et al. Post-stroke apathy: an exploratory longitudinal study. Cerebrovasc Dis, 2013, 35(6): 507-513.
24. 費鵬鴿, 李麗平, 宋景貴. 氟西汀治療腦卒中后抑郁療效的Meta分析. 中國實用神經疾病雜志, 2016, 19(11): 1-3.
25. 王娟, 何超, 余雨. 舍曲林治療卒中后抑郁的Meta分析. 重慶醫學, 2016, 45(22): 3100-3103, 3111.
26. 陽中明. 米氮平治療腦卒中后抑郁對照研究的Meta分析. 臨床合理用藥雜志, 2013, 6(12): 3-4.
27. 韓琳, 陳寧, 何俐. 抗抑郁藥預防卒中后抑郁有效性的Meta分析. 中國循證醫學雜志, 2015, 15(10): 1153-1160.
28. House A. Escitalopram may improve some cognitive functions after stroke in non-depressed patients. Evid Based Ment Health, 2010, 13(3): 81.
29. Gu SC, Wang CD. Early selective serotonin reuptake inhibitors for recovery after stroke: a meta-analysis and trial sequential analysis. J Stroke Cerebrovasc Dis, 2018, 27(5): 1178-1189.
30. Hackett ML, Anderson CS, House AO, et al. Management of depression after stroke: a systematic review of pharmacological therapies. Stroke, 2005, 36(5): 1092-1097.
31. Palom?ki H, Kaste M, Berg A, et al. Prevention of poststroke depression: 1 year randomised placebo controlled double blind trial of mianserin with 6 month follow up after therapy. J Neurol Neurosurg Psychiatry, 1999, 66(4): 490-494.
32. Narushima K, Kosier JT, Robinson RG. Preventing poststroke depression: a 12-week double-blind randomized treatment trial and 21-month follow-up. J Nerv Ment Dis, 2002, 190(5): 296-303.
33. 王同顯, 于瑞寶, 喬顯森. 選擇性血清素再攝取抑制劑類抗抑郁藥物相關出血風險. 中國輸血雜志, 2014, 27(4): 448-451.
34. Quinn GR, Singer DE, Chang Y, et al. Effect of selective serotonin reuptake inhibitors on bleeding risk in patients with atrial fibrillation taking warfarin. Am J Cardiol, 2014, 114(4): 583-586.
35. Sayal KS, Duncan-McConnell DA, McConnell HW, et al. Psychotropic interactions with warfarin. Acta Psychiatr Scand, 2000, 102(4): 250-255.

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Efficacy and safety of escitalopram in preventing post-stroke depression: a meta-analysis

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