Efficacy and safety of escitalopram in preventing post-stroke depression: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Sijie , ZHANG Jun , LIU Ruming , LI Qian , HUANG Hua , WANG Jingjing ,  YAO Qin

Department of Clinical Pharmacy, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, P.R.China;

Corresponding author：

YAO Qin, Email: 2335799@qq.com

Keywords：

Escitalopram; Post-stroke depression; Prevention; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.201905090

Video：

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Objectives To systematically review the efficacy and safety of escitalopram in the prevention of post-stroke depression (PSD).Methods PubMed, The Cochrane Library, CBM, WanFang Data, VIP and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) on escitalopram in preventing PSD from inception to March 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.Results A total of 6 RCTs involving 891 patients were included. The results of meta-analysis showed that: compared with the control group, the escitalopram group could reduce the incidence of PSD (RR=0.55, 95%CI 0.31 to 0.98, P=0.04). In addition, there was no statistical difference between escitalopram group and control group in rate of adverse events (P≥0.05).Conclusions Current evidence shows that escitalopram can reduce the incidence of PSD without increasing the incidence of adverse reactions. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

Citation： WANG Sijie, ZHANG Jun, LIU Ruming, LI Qian, HUANG Hua, WANG Jingjing, YAO Qin. Efficacy and safety of escitalopram in preventing post-stroke depression: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2019, 19(10): 1181-1186. doi: 10.7507/1672-2531.201905090 Copy

1.	王少石, 周新雨, 朱春燕. 卒中后抑郁临床实践的中国专家共识. 中国卒中杂志, 2016, 11(8): 685-693.
2.	Hackett ML, Pickles K. Part I: frequency of depression after stroke: an updated systematic review and meta-analysis of observational studies. Int J Stroke, 2014, 9(8): 1017-1025.
3.	Ayerbe L, Ayis S, Wolfe CD, et al. Natural history, predictors and outcomes of depression after stroke: systematic review and meta-analysis. Br J Psychiatry, 2013, 202(1): 14-21.
4.	Xu JH, Jiang P. Efficacy of escitalopram oxalate for patients with post-stroke depression. Medicine (Baltimore), 2018, 97(14): e0219.
5.	脑卒中患者临床神经功能缺损程度评分标准(1995). 中华神经科杂志, 1996, (6): 62-64.
6.	American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th edition, DSM-Ⅳ. Washington, DC: APA, 1994.
7.	American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 3th edition, DSM-Ⅲ-R. Washington, DC: APA, 1987.
8.	世界卫生组织. 精神与行为障碍分类: 研究用诊断标准. 刘平, 许又新(译). 北京: 人民卫生出版社, 1995: 138-139.
9.	中华医学会精神科学会, 南京医科大学脑科医院. 中国精神疾病分类方案与诊断标准. 南京: 东南大学出版社, 1995: 107.
10.	中华医学会精神病学分会. 中国精神障碍分类与诊断标准第三版(精神障碍分类). 中华精神科杂志, 2001, 34(3): 184-188.
11.	Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry, 1960, 23: 56-62.
12.	Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand, 1983, 67(6): 361-370.
13.	Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry, 1979, 134(6): 382-389.
14.	Higgins JPT, Green S. Assessing risk of bias in included studies: Cochrane handbook for systematic reviews of interventions 5.1.0. The Cochrane Collaboration, 2011, Available at: www.cochranehandbook.org.
15.	Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med, 2002, 21(11): 1539-1558.
16.	Jorge RE, Acion L, Moser D, et al. Escitalopram and enhancement of cognitive recovery following stroke. Arch Gen Psychiatry, 2010, 67(2): 187-196.
17.	Mikami K, Jorge RE, Moser DJ, et al. Prevention of poststroke apathy using escitalopram or problem-solving therapy. Am J Geriatr Psychiatry, 2013, 21(9): 855-862.
18.	Robinson RG, Jorge RE, Long J. Prevention of poststroke mortality using problem-solving therapy or escitalopram. Am J Geriatr Psychiatry, 2017, 25(5): 512-519.
19.	Robinson RG, Jorge RE, Moser DJ, et al. Escitalopram and problem-solving therapy for prevention of poststroke depression: a randomized controlled trial. JAMA, 2008, 299(20): 2391-2400.
20.	Kim JS, Lee EJ, Chang DI, et al. Efficacy of early administration of escitalopram on depressive and emotional symptoms and neurological dysfunction after stroke: a multicentre, double-blind, randomised, placebo-controlled study. Lancet Psychiatry, 2017, 4(1): 33-41.
21.	赵新慧, 温进哲, 袁芳. 草酸艾司西酞普兰预防卒中后抑郁的临床观察. 现代药物与临床, 2014, 29(3): 269-272.
22.	Sánchez C, Bøgesø KP, Ebert B, et al. Escitalopram versus citalopram: the surprising role of the R-enantiomer. Psychopharmacology (Berl), 2004, 174(2): 163-176.
23.	Caeiro L, Ferro JM, Pinho E Melo T, et al. Post-stroke apathy: an exploratory longitudinal study. Cerebrovasc Dis, 2013, 35(6): 507-513.
24.	费鹏鸽, 李丽平, 宋景贵. 氟西汀治疗脑卒中后抑郁疗效的Meta分析. 中国实用神经疾病杂志, 2016, 19(11): 1-3.
25.	王娟, 何超, 余雨. 舍曲林治疗卒中后抑郁的Meta分析. 重庆医学, 2016, 45(22): 3100-3103, 3111.
26.	阳中明. 米氮平治疗脑卒中后抑郁对照研究的Meta分析. 临床合理用药杂志, 2013, 6(12): 3-4.
27.	韩琳, 陈宁, 何俐. 抗抑郁药预防卒中后抑郁有效性的Meta分析. 中国循证医学杂志, 2015, 15(10): 1153-1160.
28.	House A. Escitalopram may improve some cognitive functions after stroke in non-depressed patients. Evid Based Ment Health, 2010, 13(3): 81.
29.	Gu SC, Wang CD. Early selective serotonin reuptake inhibitors for recovery after stroke: a meta-analysis and trial sequential analysis. J Stroke Cerebrovasc Dis, 2018, 27(5): 1178-1189.
30.	Hackett ML, Anderson CS, House AO, et al. Management of depression after stroke: a systematic review of pharmacological therapies. Stroke, 2005, 36(5): 1092-1097.
31.	Palomäki H, Kaste M, Berg A, et al. Prevention of poststroke depression: 1 year randomised placebo controlled double blind trial of mianserin with 6 month follow up after therapy. J Neurol Neurosurg Psychiatry, 1999, 66(4): 490-494.
32.	Narushima K, Kosier JT, Robinson RG. Preventing poststroke depression: a 12-week double-blind randomized treatment trial and 21-month follow-up. J Nerv Ment Dis, 2002, 190(5): 296-303.
33.	王同显, 于瑞宝, 乔显森. 选择性血清素再摄取抑制剂类抗抑郁药物相关出血风险. 中国输血杂志, 2014, 27(4): 448-451.
34.	Quinn GR, Singer DE, Chang Y, et al. Effect of selective serotonin reuptake inhibitors on bleeding risk in patients with atrial fibrillation taking warfarin. Am J Cardiol, 2014, 114(4): 583-586.
35.	Sayal KS, Duncan-McConnell DA, McConnell HW, et al. Psychotropic interactions with warfarin. Acta Psychiatr Scand, 2000, 102(4): 250-255.

1. 王少石, 周新雨, 朱春燕. 卒中后抑郁临床实践的中国专家共识. 中国卒中杂志, 2016, 11(8): 685-693.
2. Hackett ML, Pickles K. Part I: frequency of depression after stroke: an updated systematic review and meta-analysis of observational studies. Int J Stroke, 2014, 9(8): 1017-1025.
3. Ayerbe L, Ayis S, Wolfe CD, et al. Natural history, predictors and outcomes of depression after stroke: systematic review and meta-analysis. Br J Psychiatry, 2013, 202(1): 14-21.
4. Xu JH, Jiang P. Efficacy of escitalopram oxalate for patients with post-stroke depression. Medicine (Baltimore), 2018, 97(14): e0219.
5. 脑卒中患者临床神经功能缺损程度评分标准(1995). 中华神经科杂志, 1996, (6): 62-64.
6. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th edition, DSM-Ⅳ. Washington, DC: APA, 1994.
7. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 3th edition, DSM-Ⅲ-R. Washington, DC: APA, 1987.
8. 世界卫生组织. 精神与行为障碍分类: 研究用诊断标准. 刘平, 许又新(译). 北京: 人民卫生出版社, 1995: 138-139.
9. 中华医学会精神科学会, 南京医科大学脑科医院. 中国精神疾病分类方案与诊断标准. 南京: 东南大学出版社, 1995: 107.
10. 中华医学会精神病学分会. 中国精神障碍分类与诊断标准第三版(精神障碍分类). 中华精神科杂志, 2001, 34(3): 184-188.
11. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry, 1960, 23: 56-62.
12. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand, 1983, 67(6): 361-370.
13. Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry, 1979, 134(6): 382-389.
14. Higgins JPT, Green S. Assessing risk of bias in included studies: Cochrane handbook for systematic reviews of interventions 5.1.0. The Cochrane Collaboration, 2011, Available at: www.cochranehandbook.org.
15. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med, 2002, 21(11): 1539-1558.
16. Jorge RE, Acion L, Moser D, et al. Escitalopram and enhancement of cognitive recovery following stroke. Arch Gen Psychiatry, 2010, 67(2): 187-196.
17. Mikami K, Jorge RE, Moser DJ, et al. Prevention of poststroke apathy using escitalopram or problem-solving therapy. Am J Geriatr Psychiatry, 2013, 21(9): 855-862.
18. Robinson RG, Jorge RE, Long J. Prevention of poststroke mortality using problem-solving therapy or escitalopram. Am J Geriatr Psychiatry, 2017, 25(5): 512-519.
19. Robinson RG, Jorge RE, Moser DJ, et al. Escitalopram and problem-solving therapy for prevention of poststroke depression: a randomized controlled trial. JAMA, 2008, 299(20): 2391-2400.
20. Kim JS, Lee EJ, Chang DI, et al. Efficacy of early administration of escitalopram on depressive and emotional symptoms and neurological dysfunction after stroke: a multicentre, double-blind, randomised, placebo-controlled study. Lancet Psychiatry, 2017, 4(1): 33-41.
21. 赵新慧, 温进哲, 袁芳. 草酸艾司西酞普兰预防卒中后抑郁的临床观察. 现代药物与临床, 2014, 29(3): 269-272.
22. Sánchez C, Bøgesø KP, Ebert B, et al. Escitalopram versus citalopram: the surprising role of the R-enantiomer. Psychopharmacology (Berl), 2004, 174(2): 163-176.
23. Caeiro L, Ferro JM, Pinho E Melo T, et al. Post-stroke apathy: an exploratory longitudinal study. Cerebrovasc Dis, 2013, 35(6): 507-513.
24. 费鹏鸽, 李丽平, 宋景贵. 氟西汀治疗脑卒中后抑郁疗效的Meta分析. 中国实用神经疾病杂志, 2016, 19(11): 1-3.
25. 王娟, 何超, 余雨. 舍曲林治疗卒中后抑郁的Meta分析. 重庆医学, 2016, 45(22): 3100-3103, 3111.
26. 阳中明. 米氮平治疗脑卒中后抑郁对照研究的Meta分析. 临床合理用药杂志, 2013, 6(12): 3-4.
27. 韩琳, 陈宁, 何俐. 抗抑郁药预防卒中后抑郁有效性的Meta分析. 中国循证医学杂志, 2015, 15(10): 1153-1160.
28. House A. Escitalopram may improve some cognitive functions after stroke in non-depressed patients. Evid Based Ment Health, 2010, 13(3): 81.
29. Gu SC, Wang CD. Early selective serotonin reuptake inhibitors for recovery after stroke: a meta-analysis and trial sequential analysis. J Stroke Cerebrovasc Dis, 2018, 27(5): 1178-1189.
30. Hackett ML, Anderson CS, House AO, et al. Management of depression after stroke: a systematic review of pharmacological therapies. Stroke, 2005, 36(5): 1092-1097.
31. Palomäki H, Kaste M, Berg A, et al. Prevention of poststroke depression: 1 year randomised placebo controlled double blind trial of mianserin with 6 month follow up after therapy. J Neurol Neurosurg Psychiatry, 1999, 66(4): 490-494.
32. Narushima K, Kosier JT, Robinson RG. Preventing poststroke depression: a 12-week double-blind randomized treatment trial and 21-month follow-up. J Nerv Ment Dis, 2002, 190(5): 296-303.
33. 王同显, 于瑞宝, 乔显森. 选择性血清素再摄取抑制剂类抗抑郁药物相关出血风险. 中国输血杂志, 2014, 27(4): 448-451.
34. Quinn GR, Singer DE, Chang Y, et al. Effect of selective serotonin reuptake inhibitors on bleeding risk in patients with atrial fibrillation taking warfarin. Am J Cardiol, 2014, 114(4): 583-586.
35. Sayal KS, Duncan-McConnell DA, McConnell HW, et al. Psychotropic interactions with warfarin. Acta Psychiatr Scand, 2000, 102(4): 250-255.

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Efficacy and safety of escitalopram in preventing post-stroke depression: a meta-analysis

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