Prevention of Poststroke Apathy Using Escitalopram or Problem-Solving Therapy

Mikami, Katsunaka; Jorge, Ricardo E.; Moser, David J.; Arndt, Stephan; Jang, Mi-Jin; Solodkin, Ana; Small, Steven L.; Fonzetti, Pasquale; Hegel, Mark T.; Robinson, Robert G.

doi:10.1016/j.jagp.2012.07.003

Cited by 34 publications

(23 citation statements)

References 24 publications

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“…However, the difference between the two treatment arms was not appreciable (39). Yet, escitalopram has been shown to be more effective than placebo in preventing new onset of apathy following stroke (40). …”

Section: Discussionmentioning

confidence: 99%

Apathy in Late-Life Depression: Common, Persistent, and Disabling

Yuen

Bhutani

Lucas

et al. 2015

The American Journal of Geriatric Psychiatry

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Objectives The aims of this study were to examine: (1) the relationship between apathy and disability in late-life depression, and (2) the functional significance of improvement in apathy following escitalopram treatment in terms of its relationship to disability. Methods Subjects were 71 non-demented elderly with non-psychotic major depression. After a 2-week single-blind placebo period, subjects who had Hamilton Depression Rating Scale (HDRS) ≥ 18 received escitalopram 10mg daily for 12 weeks. Apathy and disability were assessed with the Apathy Evaluation Scale (AES) and the World Health Organization Disability Assessment Scale II (WHODAS) respectively. These measures and the HDRS were administered at baseline and again following 12 weeks of treatment. Results At baseline, 38% of depressed subjects had significant apathy (AES ≥ 36.5). Severity of apathy at baseline significantly correlated with severity of disability. In a multivariate regression model, baseline severity of apathy, but not the overall depressive syndrome (HDRS), significantly correlated with baseline disability. Following escitalopram treatment, improvement in apathy significantly correlated with improvement in disability measures, while change in the rest of the depressive syndrome did not. The overall change in apathy and disability in response to escitalopram treatment was significant but small. Conclusions Apathy is common in late-life depression and is associated with disability above and beyond the influence of other depressive symptoms. Given the strong relationship between apathy and disability, understanding the neurobiology of apathy and developing treatments for apathy may improve the functional outcomes of late-life depression.

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Section: Discussionmentioning

confidence: 99%

Apathy in Late-Life Depression: Common, Persistent, and Disabling

Yuen

Bhutani

Lucas

et al. 2015

The American Journal of Geriatric Psychiatry

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“…A recent multi-center, double-blind, randomized study of depression with apathy using SSRI or serotonin and norepinephrine reuptake inhibitor (SNRI) treatment documented the frequent persistence of apathy after an initial SSRI course and some improvement in apathy when a switch was made to treatment with either another SSRI or SNRI but without an appreciable difference between the two treatment arms(Raskin et al, 2012). On the other hand, escitalopram has been shown to be more effective than placebo in preventing new onset of apathy following stroke (Mikami et al, 2013). …”

Section: Discussionmentioning

confidence: 99%

Neuroanatomical correlates of apathy in late-life depression and antidepressant treatment response

Yuen

Gunning

Woods

et al. 2014

Journal of Affective Disorders

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Background Apathy is a prominent feature of geriatric depression that predicts poor clinical outcomes and hinders depression treatment. Yet little is known about the neurobiology and treatment of apathy in late-life depression. This study examined apathy prevalence in a clinical sample of depressed elderly, response of apathy to selective serotonin reuptake inhibitor (SSRI) treatment, and neuroanatomical correlates that distinguished responders from nonresponders and healthy controls. Methods Participants included 45 non-demented, elderly with major depression and 43 elderly comparison individuals. After a 2-week single-blind placebo period, depressed participants received escitalopram 10mg daily for 12 weeks. The Apathy Evaluation Scale (AES) and 24-item Hamilton Depression Rating Scale (HDRS) were administered at baseline and 12 weeks. MRI scans were acquired at baseline for concurrent structural and diffusion tensor imaging of anterior cingulate grey matter and associated white matter tracts. Results 35.5% of depressed patients suffered from apathy. This declined to 15.6% (p<0.1) following treatment, but 43% of initial sufferers continued to report significant apathy. Improvement of apathy with SSRI was independent of change in depression but correlated with larger left posterior subgenual cingulate volumes and greater fractional anisotropy of left uncinate fasciculi. Limitations modest sample size, no placebo control, post-hoc secondary analysis, use of 1.5T MRI scanner Conclusions While prevalent in geriatric depression, apathy is separable from depression with regards to medication response. Structural abnormalities of the posterior subgenual cingulate and uncinate fasciculus may perpetuate apathetic states by interfering with prefrontal cortical recruitment of limbic activity essential to motivated behavior.

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“…Other aspects of stroke recovery have been studied in RCTs including cognitive function among 129 patients and apathy among 154 patients receiving escitalopram, placebo or problem-solving therapy. In both studies SSRI treatment was associated with improved outcome and they reported no differences in adverse events between treated and non-treated groups [15,16]. In an observational, prospective study on the use of pharmacological augmentation in stroke recovery, 31 of the 249 patients included were treated with SSRIs exclusively to enhance rehabilitation [17].…”

Section: Ssris For Stroke Recoverymentioning

confidence: 99%

Safety of selective serotonin reuptake inhibitor treatment in recovering stroke patients

Mortensen

Andersen²

2015

Expert Opinion on Drug Safety

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Evidence suggests that SSRIs may enhance stroke recovery. Most studies on cerebrovascular risk are from non-stroke populations and little is known about recurrent events and mortality post-stroke. In non-stroke populations treatment has been associated with increased risk of intracerebral and intracranial hemorrhage; however the absolute risk is low. The association between SSRIs and ischemic stroke is less clear. Randomized stroke trials indicate that treatment is safe and well tolerated, and the most common side effects are often benign and transient. The trials are small however and not powered to detect potential differences in cerebrovascular events. We await several ongoing large randomized trials before SSRIs can be recommended as a routine pharmacotherapy in stroke recovery.

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Prevention of Poststroke Apathy Using Escitalopram or Problem-Solving Therapy

Cited by 34 publications

References 24 publications

Apathy in Late-Life Depression: Common, Persistent, and Disabling

Apathy in Late-Life Depression: Common, Persistent, and Disabling

Neuroanatomical correlates of apathy in late-life depression and antidepressant treatment response

Safety of selective serotonin reuptake inhibitor treatment in recovering stroke patients

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