Feasibility and Effectiveness of Treatments for Post-Stroke Depression in Elderly Inpatients: Systematic Review

Abstract

To determine the feasibility and effectiveness of antidepressive treatments for post-stroke depression in elderly medical inpatients, MEDLINE was searched for potentially relevant articles published from January 1987 to August 1997 using the keywords "depression or depressive disorder" (exploded) and "aged." Thirteen reports met the following inclusion criteria: (1) published in English or French; (2) minimum age criterion of 55 and over or mean age 65 and over; (3) post-stroke subjects admitted to a medical, geriatric, or rehabilitation service; (4) used accepted criteria for depression; (5) examined treatment(s) for depression; and (6) reported outcomes as a depression diagnosis and/or symptom level. Data were abstracted independently from each article by two reviewers. The limited evidence suggests contraindications to treatment of 83% of a group to receive a heterocyclic antidepressant compared with 11% of a group to receive a selective serotonin reuptake inhibitor (SSRI); rates of discontinuation and study completion are similar for heterocyclics, SSRIs and psychostimulants. All of the treatments appear to be at least modestly effective in the short term.

Guideline for the management of late‐life depression in primary care

“…Data from the three meta-analyses can be summarised: (1) there are no significant differences in efficacy between different classes of antidepressants; (2) adverse events appear to be similar across classes; (3) tricyclic antidepressants may be more effective in more severe depression, although one recent study did not confirm this (Mulsant et al, 2001a). Although efficacy and tolerability data from clinical trials show little difference between SSRIs and tricyclic antidepressants, there is evidence from naturalistic studies that more older depressed patients with medical comorbidity have contraindications to tricyclics than SSRIs (Cole et al, 2001) and under-treatment is more common with tricyclics than SSRIs (Rojas-Fernandez et al, 1999). Medical co-morbidity is discussed later.…”

Veterans Affairs/Department of Defense Clinical Practice Guideline for the Management of Adult Stroke Rehabilitation Care

“…Once diagnosed, treatment of depression and other emotional disorders can greatly improve rehabilitation outcomes 101,102 (Evidence LevelϭA). Treatment with psychotherapy (Evidence LevelϭC) and/or pharmacotherapy (Evidence LevelϭA) can stabilize mood and improve ability to participate in therapies.…”

Update on depression in neurologic illness: Stroke, epilepsy, and multiple sclerosis

“…Cole et al [29] reviewed the literature from 1987 through 1997 on treating PSD in the elderly, with limited evidence suggesting that 83% of the patients had contraindications to heterocyclic antidepressants compared with 11% of patients unable to take a selective serotonin reuptake inhibitor (SSRI). However, because of their antiplatelet effect, SSRIs may not be the treatment of choice in hemorrhagic stroke.…”