Stroke: depression: fluoxetine helps improve it

Clinical bottom line (level 1b)

  1. Patients with post-stroke depression who take fluoxetine compared with placebo are less depressed after 6 weeks.
Wiatt et al: Stroke 2000; 31 : 1829-1832
Expires June 2004

The study

Double-blinded ?concealed randomised trial with intention-to-treat
Setting: neurorehabilitation unit, France

31 patients (aged mean 67, 52% male) with a single ischaemic or haemorrhagic stroke within the previous 3 months (confirmed on CT or MRI scan), and symptoms of major depression (based on ICD-10)

Excluded if
  • history of severe psychiatric problems requiring hospitalization
  • chronic alcoholism
  • previous stroke
  • chronic associated handicapping pathology
  • severe cognitive deficit assessed by minimental state examination < 23
  • severe aphasia
  • contraindication to fluoxetine
  • taken antidepresant or neuroleptic drug within 10 days

    Note:
  • Patients were assessed by a neuropsychiatrist using the Montgomery-Aaberg Deprssion Rating Scale (MADRAS)

    Control Group: (n = 15, 15 analysed): placebo
    Experimental Group: (n = 16, 16 analysed): fluoxetine 20 mg daily

    90% followed for 45 days

    The evidence

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    MADRAS score 18.7
    (10.0)     		11.8
    (6.7)     		6.9
    (0.69 to 13)

    Citation

    1. Wiatt L, Petit H, Joseph PA, et al: fluoxetine in early poststroke depression: a double-blind placebo-controlled study. Stroke 2000; 31 : 1829-1832
    Search Terms:
    Contributor: Chris Ball, June 2001
    Reviewer:

    Clinical Question.
    Patient post-stroke depression
    Intervention or Exposure fluoxetine
    Comparison placebo
    Outcome improvement in depression
    		•