Antidepressants may deliver different efficacies in post-stroke depressive symptoms (PSD). So a study investigated the effectiveness of escitalopram on PSD, based on distinct depressive symptoms and stroke lesion location.

Depressive manifestations were assessed by employing the Montgomery-Åsberg Depression Rating Scale (MADRS). Shifts in MADRS and individual item scores after 12 weeks were compared between the treatment and the stroke lesion location groups. 

Stroke lesion locations were clustered based on the anatomical distribution of serotonin fibers originating from the midbrain/pons and spreading to the forebrain via subcortical structures: “Midbrain-Pons,” “Frontal-Subcortical,” and “Others.” 

Total MADRS scores were seen to be markedly reduced in the escitalopram than in the placebo group.

However, escitalopram displayed a substantial effect in exclusively 3 items: apparent sadness, reported sadness, and pessimistic thoughts. 

The lesion location analyses showed escitalopram users in the Frontal-Subcortical group to have significant improvement in total MADRS scores, but not in the Midbrain-Pons and Others groups.

These outcomes suggest a more pronounced effect of escitalopram on PSD in patients with certain depressive symptoms and stroke lesion locations. Thus the treatment strategies must be tailored accordingly.

Source: Journal of Geriatric Psychiatry and Neurology. 2021;34(6):565-573. doi:10.1177/0891988720957108