Neurológia pre prax 6/2021

Antidepressants for prophylaxis and treatment of post-stroke depression

One-third of stroke survivors develop post-stroke depression (PSD), which has a negative impact on mortality, degree of disability, and overall prognosis. Hence, early initiation of antidepressants (ADs) could prevent the development of depression and (or at the same time) improve the post-stroke recovery. However, a series of recent multicenter studies do not demonstrate the efficacy of fluoxetine either in preventing depression or in other clinical indicators. Thus, the prophylactic indication of antidepressants currently lacks evidence. In the treatment of post-stroke depression, ADs (SSRI as the first choice) are still indicated, and studies to date have shown a moderate effect. However, large and long-term studies clearly demonstrating the efficacy and safety of ADs are still lacking. In addition, the growing interest in neurostimulation and psychosocial interventions indicates a trend toward a multimodal approach to PSD treatment.

Keywords: stroke, post-stroke depression, depression, antidepressants, prophylaxis, SSRIs, fluoxetine