Different interventions for post-ischaemic stroke depression in different time periods: a single-blind randomized controlled trial with stratification by time after stroke

Abstract

Objective: To determine the appropriate treatments for post-ischaemic stroke depression at different times after stroke.

Design: A single-blind, randomized, controlled trial that compared three intervention groups, with subgroups stratified by time after stroke.

Setting: Outpatient clinic.

Subjects: Eligible patients were recruited at discharge ( n = 73) and three ( n = 67), six ( n = 65), and nine months ( n = 69) after discharge, and patients completed mood questionnaires.

Interventions: Patients were randomly distributed into three groups: Group A received placebos and participated in general discussions; Group B, received citalopram and participated in general discussions; and Group C, received placebos and underwent cognitive behavioural therapy. All three groups participated in rehabilitation during three months of follow-up.

Main measures: Outcome was assessed three months after baseline using the 17-item Hamilton Depression Scale (HAMD₁₇) and the Bech-Rafaelsen Melancholia Scale (MES). During treatment, the Udvalg for Kliniske Undersogelser side-effect scale was also administered.

Results: When stratification was not considered, the scores of Group B on the Melancholia Scale were lower than those of Group A ( P = 0.02); when the four time-based subgroups were analysed, significant differences were observed between Groups A and B (P_MES = 0.02, P_HAMD17 = 0.02) in the group recruited six months after discharge and between Groups A and C (P_MES = 0.01) in the last time period nine months after discharge.

Conclusions: The effects of citalopram or cognitive behavioural therapy is similar to the effect of rehabilitation alone for early-onset post-ischaemic depression; rehabilitation and citalopram for delayed-onset post-ischaemic depression; and rehabilitation and cognitive behavioural therapy for late-onset post-ischaemic depression are more effective than rehabilitation alone.

Keywords: Depression; antidepressive agents; psychotherapy; rehabilitation; stroke.