- An analysis of 12 trials suggests that paroxetine (Paxil, Pexeva) might be the best choice for post-stroke depression whereas fluoxetine (Prozac, Sarafem) looks like the least-viable option.
Why this matters
- About one third of stroke survivors experience depression.
- Meta-analysis of 12 trials (N=707).
- After a multiple-treatments meta-analysis, the researchers sorted individual drugs by efficacy using an approach that ranks each intervention based on comparison to an imaginary, maximally optimal intervention.
- Funding: The Program of Liaoning Province Education Administration, The Shenyang Population and Health Technical Critical Special Project, and The Program of the Distinguished Professor of Liaoning Province, Neurology.
- For efficacy, the top 3 drugs were reboxetine (Edronax, Prolift; 100%), paroxetine (85.7%), and doxepin (Silenor; 83.2%); the worst were sertraline (Zoloft; 36.1%), nefiracetam (Racetam; 14.1%), and fluoxetine (2.3%).
- Placebo was ranked at 16.3% for efficacy.
- Regarding acceptability, the top 3 drugs were paroxetine (92.4%), sertraline (57.3%), and nortriptyline (Pamelor, Aventyl; 56.3%); the worst were doxepin (31.6%), fluoxetine (27.5%), and citalopram (Celexa; 22.5%).
- Studies had small sample sizes and short treatment durations.