Depressive Symptoms in Stroke Patients: Are There Sex Differences?

Abstract

Background: We aimed to examine sex differences in symptom characteristics and pharmacological responses in post-stroke depressive (PSD) symptoms. Methods: This is a post hoc analysis of EMOTION (ClinicalTrials.gov, NCT01278498), a randomized, placebo-controlled, double-blind trial that examined the efficacy of escitalopram for 3 months on depression in patients with acute stroke. Depressive symptoms were evaluated using the 10-item Montgomery-Åsberg Depression Rating Scale (MADRS). Baseline characteristics, clinical variables, and treatment responses to escitalopram were compared between male and female patients. Treatment responses were defined as changes in MADRS (total score and its components) between baseline and 3 months and were compared between the escitalopram and placebo groups within each sex group. The least square mean was calculated to determine the independent effect of escitalopram, of which interaction was evaluated with patient sex. Results: Of the 478 patients (intention-to-treat population), 187 (39%) were female. Female patients were significantly older than male patients and demonstrated more severe depressive symptoms at baseline (male vs. female, MADRS score, mean [SD]: 9.7 ± 8.0 vs. 12.2 ± 8.4, p = 0.001), especially in apparent sadness, reported sadness, and reduced appetite items. These differences were significant after adjustment for age and the severity of neurologic deficits. The female escitalopram group showed a significant 3-month improvement in MADRS scores (placebo [n = 86] vs. escitalopram [n = 101], least square mean [95% CI] –2.7 [–4.1 to –1.2] vs. –5.0 [–6.4 to –3.6], p = 0.007), and this efficacy was prominent in apparent sadness, reported sadness, and pessimistic thoughts items. However, there was no significant effect of escitalopram on depressive symptoms in the male group. The treatment responses of escitalopram tended to be more pronounced in the female group, particularly in alleviating a subset of depressive symptoms such as apparent sadness (p for interaction = 0.009). Conclusion: PSD may differ according to sex in its symptom characteristics and treatment responses to escitalopram, and tailored treatment strategies for PSD may therefore be needed.

Sex Differences in the Brain-Blood Barrier in Rats Exposed to Early life Stress and the Treatment with Antidepressants and Psychobiotic

“…This antioxidant and anti-in ammatory action could, at least in part, justify the results found in the present study. Interestingly, a clinical study with individual with post-stroke depressive symptoms evidenced that treatment responses of escitalopram tended to be more pronounced in the female group, suggesting different responses according to sex, going according to the data observed in the present study (Lee et al 2020). Moreover, after review 15 randomized, placebo-controlled trials, Khan et al (2005) observed that women had a signi cantly greater response than men to SSRI antidepressants (Khan et al 2005).…”

Sex Differences in Depressive Symptoms in 1308 Patients Post-Stroke at Entry to Cardiac Rehabilitation

“…The significantly higher prevalence of PSDS in women than men in bivariate analyses (38.6% women vs 26.6% men, P < .001) aligns with some but not all studies 21 , 22 , 25 , 26 , 48 , 49. Furthermore, in the same CR program using the same depression screening tool, this primary finding was similar to that of cardiac patients except that the proportion with depressive symptoms was lower for both women and men with cardiac disease (30.2 vs 19.3%, P < .001) 27…”

Sleep Disorders in Stroke: An Update on Management

“…PSD usually presents during two ranges after stroke: one between 3-6 months and the other between 2-3 years after stroke [118]. With the same clinical manifestations of traditional depression, PSD is mainly characterized by mood dysfunctions including depressive feelings, indifference, irritability, and vegetative signs including sleep disorders [119,120]. Despite the similarity to other depressed patients with atherosclerotic diseases, the symptoms of depression were more severe in patients with PSD than in those with atherosclerotic diseases [121].…”