Antidepressant may help cognitive recovery after stroke

Treatment with the antidepressant escitalopram may enhance cognitive recovery after stroke, according to a new study.

Researchers at the University of Iowa conducted a single-center study to determine if therapy with escitalopram would affect cognitive outcomes after stroke. Within three months of an index stroke, patients were assigned to a double-blind, placebo-controlled arm that compared escitalopram with placebo or a nonblinded arm involving problem-solving therapy, a psychological treatment that teaches patients how to deal with their problems. The main outcome measures were changes in several neuropsychological tests, including the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), performed at baseline and at the end of the intervention period. The study was funded by the National Institute of Mental Health and was published in the February Archives of General Psychiatry.

One hundred twenty-nine patients were randomly assigned–43 to escitalopram, 45 to placebo, and 41 to problem-solving therapy–but 12 withdrew before beginning treatment and seven withdrew after treatment began. Patients who were randomly assigned to problem-solving therapy were older than patients in the other two groups. At 12 months, the authors found that escitalopram had a significant effect on total RBANS score (adjusted mean change, 10.0 in the escitalopram group vs. 3.1 in the nonescitalopram groups; P<0.01) and RBANS delayed memory score (adjusted mean change, 11.3 in the escitalopram group vs. 2.5 in the nonescitalopram groups; P<0.01). Rates of adverse events did not differ among groups.

The authors acknowledged their study's limitations, including the limited generalizability of their findings and the difference in age between patients who received escitalopram and those who did not. However, they concluded that escitalopram was associated with improved global cognitive function, specifically verbal and visual memory, in patients who had had a stroke, independent of its effects on depression. “The utility of antidepressants in the process of poststroke recovery deserves to be further investigated,” the authors wrote.