Effects of the prophylactic use of escitalopram on the prognosis and the plasma copeptin level in patients with acute cerebral infarction

Abstract

This study aimed to investigate whether the routine administration of escitalopram for three months would improve the prognosis of patients with ischemic stroke and decrease the plasma copeptin level. A total of 97 patients with acute cerebral infarction were randomly allocated to receive escitalopram (5-10 mg once per day, orally; n=49) or not to receive escitalopram (control group; n=48) for 12 weeks starting at 2-7 days after the onset of stroke. Both groups received conventional treatments, including physiotherapy and secondary prevention of stroke. The National Institutes of Health Stroke Scale (NIHSS) score was used to evaluate the disability of patients at the initial evaluation and at the monthly follow-up visits for three months. Impairment in the daily activities was assessed using the Barthel Index (BI), while cognitive impairment was assessed using Mini-Mental State Examination (MMSE) score. The psychiatric assessment included the administration of the Present State Examination modified to identify Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) symptoms of depression. The severity of depression was measured using the 17-item Hamilton Rating Scale for Depression (HAMD). During the 3month follow-up period, 95 patients were included in the analysis (two patients withdrew from the escitalopram group). NIHSS and BI improvement at the 90th day were significantly greater in the escitalopram group (Po0.05), while HAMD and plasma copeptin levels significantly decreased, compared to the control group (Po0.01). In patients with acute ischemic stroke, the earlier administration of escitalopram for three months may improve neurological functional prognosis and decrease copeptin level.

Preventive Approaches for Post-Stroke Depression: Where Do We Stand? A Systematic Review

“…Study durations ranged from 3 to 12 months. Seven out of 11 studies reported the efficacy of antidepressive medication, including mirtazapine (n=70, 27 PSD in 5.7% mirtazapine vs 40% non-treated, P =0.001), milnacipran (n=92, 28 PSD in 2.2% milnacipran vs 15.2% placebo, P =0.048), sertraline (n=137, 31 PSD in 10% sertraline vs 30% placebo, P ≤0.05), fluoxetine (n=3127, 34 PSD in 13.4% fluoxetine vs 17.2% placebo, P =0.0033; and n=1500, 37 PSD in 7% fluoxetine vs 11% placebo, P =0.015), duloxetine (n=97, 35 PSD in 8.3% duloxetine vs 24.5% control, P <0.05), and escitalopram (n=97, 36 PSD in 10.2% escitalopram vs 50.3% control, P <0.01) in preventing PSD. The results of four trials indicated that sertraline (n=111), 30 escitalopram (n=478), 32 fluoxetine (n=1280), 29 and mianserin (n=100) 33 do not prevent PSD in stroke survivors.…”

“… 29 , 34 , 37 Two out of three studies (67%) described a preventive effect of PSD after a 3-month treatment regimen with duloxetine or escitalopram. 32 , 35 , 36 Fluoxetine has been investigated for its effects on functional outcome as the primary outcome and depression as the secondary outcome in stroke patients by three large multicenter RCTs. Patients who were enrolled in these studies had the common characteristic of having had acute stroke in the previous 2–15 days, brain imaging consistent with ischemic or hemorrhagic stroke, and a persisting neurological deficit.…”

How antidepressants affect the cerebral ischemic injury and ischemic stroke

“…If antidepressants can be used within four weeks of stroke, physical, cognitive and neurological functions will have significant improvements [7]. A clinical trial of 97 hospitalized-patients suffered for acute ischemic stroke found that the prophylactic use of escitalopram might exhibit significant therapeutic effects, has few side effects, ameliorate the degree of neurological deficit and depression, and prevent post-stroke depression, which will be beneficial to the prognosis of patients with acute cerebral infarction [9].…”

Prävention der Post-Stroke-Depression

“…Hinweise auf die Wirksamkeit antidepressiver Substanzen (Mirtazapin, Milnacipran, Sertralin, Fluoxetin, Duloxetin und Escitalopram) zur Prävention einer PSD lieferten eine Reihe randomisierter kontrollierter Studien 9 10 11 12 13 . In weiteren klinischen Studien zu den Substanzen Fluoxetin (n=1280), Sertralin (n=111 und n=122), Escitalopram (n=478) und Mianserin (n=100) blieb der Nachweis einer antidepressiven Wirksamkeit in Bezug auf PSD jedoch aus 14 15 16 17 18 19 20 .…”