The present study examined sex differences in symptom characteristics and pharmacological responses to post-stroke depressive (PSD) symptoms.

This study was the post hoc analysis of EMOTION that examined the efficacy of Escitalopram for three months on depression in patients with acute stroke. It evaluated the Depressive symptoms using the 10-item Montgomery-Åsberg Depression Rating Scale (MADRS). It compared baseline characteristics, clinical variables, and treatment responses [defined as changes in MADRS (total score and its components) between baseline and three months] to Escitalopram between male and female patients. 

The study found that out of the 478 patients (intention-to-treat population), 39% were female. Female patients were older than male patients and presented more severe depressive symptoms at baseline, especially in apparent sadness, reported sadness, and reduced appetite items. These differences remained significant after adjusting for age and the severity of neurologic deficits. The female escitalopram group showed a significant 3-month improvement in MADRS scores, and this efficacy was prominent in apparent sadness, reported sadness, and pessimistic thoughts items. However, the male group showed no significant effect of Escitalopram on depressive symptoms. The treatment responses of Escitalopram were more marked in the female group, particularly in reducing a subset of depressive symptoms such as apparent sadness. 

This study shows the variation in PSD according to sex in its symptom characteristics and treatment responses to Escitalopram. Thus tailored treatment strategies for PSD may be needed.

Lee E-J, Kim JS, Chang DI, et al. Depressive Symptoms in Stroke Patients: Are There Sex Differences? Cerebrovasc Dis 2020;49:19-25. doi: 10.1159/000506116