Effıcacy of cıtalopram on stroke recurrence: A randomızed clınıcal trıal. (July 2022)

• Record Type: Journal Article
• Authors: Ece Çetin, Fatma; Kumral, Emre; Saffet Gönül, Ali; Nezih Özdemir, Hüseyin; Orman, Mehmet
• Is Part Of: Journal of clinical neuroscience. Volume 101(2022)
• Page Start: 168
• Page End: 174
• Publication Date: 2022-07
• Subjects: Mood disorder -- Citalopram -- Outcome -- Stroke recurrence; SSRIs Selective serotonin reuptake inhibitors -- SNRIs Selective serotonin norepinephrine reuptake inhibitors -- NaSSAs Noradrenergic and specific serotonergic antidepressants -- PSD Post stroke depression -- DSM-IV and V Diagnostic and Statistical Manual of Mental Disorders -- HAM-DRS Hamilton Depression Rating Scale -- MMSE Mini-Mental State Examination -- RAVLT Rey Auditory Verbal Learning Test -- DWI Diffusion weighted imaging -- FLAIR Fluid-attenuated inversion recovery; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2022.05.014
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Depression is associated with an increased risk of recurrent stroke, and cardiovascular diseases. Depression treatment has an effect in protecting patients from recurrent stroke and cardiovascular events. Executive processing disorder has a prominent effect on the stroke recurrence. The risk of recurrence of stroke is significantly higher in those who did not display an improvement. Abstract: Post-stroke depression is one of the main causes of cerebrovascular and cardiovascular diseases. The aim of the present study was to investigate the efficacy of citalopram on stroke recurrence. A 52-week, randomized, double-blind, study involved 440 ischemic stroke patients with depression. Patients with depression who met depression criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV and V) and Hamilton Depression Rating Scale ≥ 8 (HAM-DRS) were dichotomized into patients receiving citalopram (225 patients), titrated according to clinical response, and patients with placebo (215 patients) for 52 weeks. The primary outcome measure was stroke recurrence and the secondary outcome measures were cardiovascular events and mortality. Stroke recurrence (66% vs 34%; P = 0.001) and cardiovascular events (76% vs. 24%; P = o.oo1) were significantly higher in the placebo group compared to those treated with citalopram. Multivariable analysis showed that hypertension, atrial fibrillation, and large-artery disease were significantly associated with stroke recurrence. Executive processing disorder was more associated with stroke recurrence than other neuropsychological disorders (OR, 1.74; CI95%, 1.04–2.89; P = 0.035). Survival analysis showed that treatment for depression interacted with time to reduce stroke recurrence by nearly half (39% vs. 61%; P = 0.05). The current study supports the importance of depression treatment in protecting the patients from recurrent strokes. This result warrants further studies to demonstrate the efficacy of depression treatment on stroke recurrence.