Objective:

The efficacy of antidepressants in post-stroke depressive symptoms (PSD) varies. We aimed to examine whether the effect of escitalopram on PSD differs according to individual depressive symptoms and stroke lesion location.

Methods:

This is a post hoc analysis of EMOTION (ClinicalTrials.gov, NCT01278498), a randomized, placebo-controlled, double-blind trial that examined the efficacy of escitalopram on depression in acute stroke patients (237 with placebo, 241 with escitalopram). Depressive symptoms were evaluated with the 10-item Montgomery-Åsberg Depression Rating Scale (MADRS). Changes in MADRS and individual item scores at 12 weeks were compared between the treatment groups and among the stroke lesion location groups. Stroke lesion locations were grouped according to the anatomical distribution of serotonin fibers that originate from the midbrain/pons and spread to the forebrain via subcortical structures: “Midbrain-Pons,” “Frontal-Subcortical,” and “Others.” Least-squares means were calculated to demonstrate the independent effect of lesion location.

Results:

Total MADRS scores decreased more significantly in the escitalopram than in the placebo group, while a significant effect of escitalopram was observed in only 3 items: apparent sadness, reported sadness, pessimistic thoughts. In the lesion location analyses, escitalopram users in the Frontal-Subcortical group showed significant improvement in total MADRS scores (placebo [n = 130] vs. escitalopram [n = 148], least-square mean [95% CI]: -2.3 [-3.5 to -0.2] vs. -4.5 [-5.5 to -3.4], p = .005), while those in the Midbrain-Pons and Others groups did not.

Conclusions:

The effect of escitalopram on PSD may be more prominent in patients with particular depressive symptoms and stroke lesion locations, suggesting the need for tailored treatment strategies.

中文翻译：

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中风后抑郁症状：个体症状和病变部位对艾司西酞普兰的不同反应。

客观的：

抗抑郁药在卒中后抑郁症状 (PSD) 中的疗效各不相同。我们旨在检查依他普仑对 PSD 的影响是否因个体抑郁症状和中风病变位置而异。

方法：

这是 EMOTION (ClinicalTrials.gov, NCT01278498) 的事后分析，这是一项随机、安慰剂对照、双盲试验，检查了艾司西酞普兰对急性卒中患者抑郁症的疗效（安慰剂组 237 例，艾司西酞普兰组 241 例）。使用 10 项蒙哥马利-奥斯伯格抑郁量表 (MADRS) 评估抑郁症状。比较治疗组和卒中病变部位组 12 周时 MADRS 和单个项目评分的变化。中风病变位置根据源自中脑/脑桥并通过皮层下结构扩散到前脑的血清素纤维的解剖分布进行分组：“中脑-脑桥”、“前额-皮层下”和“其他”。计算最小二乘平均值以证明病变位置的独立影响。

结果：

与安慰剂组相比，依他普仑的总 MADRS 评分下降更显着，而依他普仑仅在 3 个项目中观察到显着影响：明显的悲伤、报告的悲伤、悲观的想法。在病变位置分析中，额叶-皮质下组的依他普仑使用者显示总 MADRS 评分显着改善（安慰剂 [n = 130] 与依他普仑 [n = 148]，最小二乘均值 [95% CI]：-2.3 [ -3.5 到 -0.2] vs. -4.5 [-5.5 到 -3.4]，p = .005），而中脑-脑桥和其他组中的那些没有。

结论：

依他普仑对 PSD 的影响在具有特定抑郁症状和中风病变部位的患者中可能更为突出，这表明需要量身定制的治疗策略。