Escitalopram and Enhancement of Cognitive Recovery Following Stroke

Abstract

Context Adjunctive restorative therapies administered during the first few months after stroke, the period with the greatest degree of spontaneous recovery, reduce the number of stroke patients with significant disability. Objective To examine the effect of escitalopram on cognitive outcome. We hypothesized that patients who received escitalopram would show improved performance in neuropsychological tests assessing memory and executive functions than patients who received placebo or underwent Problem Solving Therapy. Design Randomized trial. Setting Stroke center. Participants One hundred twenty-nine patients were treated within 3 months following stroke. The 12-month trial included 3 arms: a double-blind placebo-controlled comparison of escitalopram (n=43) with placebo (n=45), and a nonblinded arm of Problem Solving Therapy (n=41). Outcome Measures Change in scores from baseline to the end of treatment for the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Trail-Making, Controlled Oral Word Association, Wechsler Adult Intelligence Scale–III Similarities, and Stroop tests. Results We found a difference among the 3 treatment groups in change in RBANS total score (P<.01) and RBANS delayed memory score (P<.01). After adjusting for possible confounders, there was a significant effect of escitalopram treatment on the change in RBANS total score (P<.01, adjusted mean change in score: escitalopram group, 10.0; nonescitalopram group, 3.1) and the change in RBANS delayed memory score (P<.01, adjusted mean change in score: escitalopram group, 11.3; nonescitalopram group, 2.5). We did not observe treatment effects in other neuropsychological measures. Conclusions When compared with patients who received placebo or underwent Problem Solving Therapy, stroke patients who received escitalopram showed improvement in global cognitive functioning, specifically in verbal and visual memory functions. This beneficial effect of escitalopram was independent of its effect on depression. The utility of antidepressants in the process of poststroke recovery should be further investigated. Trial Registration clinicaltrials.gov Identifier: NCT00071643

Poststroke depression and treatment effects on functional outcomes

“…Recently, it was demonstrated that antidepressant use was beneficial to cognitive recovery when initiated during the first 3 months poststroke. 26 This was regardless of change in depression. Others have found that those with depression improvement demonstrated significantly better activities of daily living functional improvement then those without a remittance of depression.…”

Exploring Standardized Zembrin® Extracts from the South African plant Sceletium tortuosum in Dual Targeting Phosphodiesterase-4 (PDE-4) and Serotonin Reuptake Inhibition as potential treatment in Schizophrenia

“…The efficacy of Selective Serotonin Reuptake Inhibitors (SSRI) in the treatment of anxiety and depressive disorders is well documented [45]. More recently escitalopram, the putative SSRI, has been shown to improve cognition and facilitate post-stroke recovery [46]. Taken together, there is growing evidence to substantiate the role played by serotonin in decision making process within the cognitive domain of executive function [47].…”

Antidepressants in the treatment of stroke

“…In a study of 20 patients, citalopram also improved neurological status (NIH Stroke Scale) 45-50 days post-stroke, when compared with placebo [52]. The SSRI escitalopram was used in a study of 129 patients enrolled within 3 months after stroke and treated for 12 months [53]. Compared with patients treated with placebo or problem-solving therapy, those given escitalopram showed greater improvement in tests of cognitive function, including verbal and visual memory (Repeatable Battery for the Assessment of Neuropsychological Status), independent of depression.…”