For post-stroke depression, which medication is best?

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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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%).

Limitations

  • Studies had small sample sizes and short treatment durations.