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Escitalopram and problem solving therapy reduce the incidence of post-stroke depression

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QUESTION

Question:

Can escitalopram or problem solving therapy prevent post-stroke depression?

Patients:

176 non-depressed participants within 3 months of haemorrhagic or ischaemic stroke. Exclusions were DSM-IV based major or minor depression (research criteria); >11 on the Hamilton-17 Depression Rating Scale; severe neuropsychological deficits; other life threatening medical conditions; neurodegenerative disorders; and DSM-IV alcohol or substance abuse or dependence within the past 12 months.

Setting:

Two university hospitals, USA; enrolment 2003–2007.

Intervention:

One of three 2 month regimens: escitalopram (10 mg/day if <65 years old, 5 mg/day if ⩾65 years old; taken in the morning), placebo pill or problem solving therapy (PST) (six sessions over the first 12 weeks and six reinforcement sessions up to 12 months). PST was delivered by therapists who had completed training in the manual based intervention and all sessions were videotaped and assessed for adherence.

Outcomes:

Major or minor depression (defined as meeting DSM-IV …

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