Abstract Details

Title Comparative Efficacy of Antidepressants for Post-stroke Depression: Bayesian Network Meta-analysis of Randomized Controlled Trials

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P9 - Poster Session 9 (5:00 PM-6:00 PM)

Poster/Presentation
Number 5-016

Objective To rank antidepressants based on their efficacy in reducing depressive and anxiety symptoms in patients with PSD, using standardized rating scales over multiple time points.

Background Post-stroke depression (PSD) is a common complication, yet the comparative efficacy of antidepressants remains uncertain. This network meta-analysis (NMA) aimed to evaluate the relative efficacy of pharmacological interventions for PSD.

Design/Methods A systematic search was conducted for randomized controlled trials (RCTs) involving adults diagnosed with PSD via DSM criteria. Pediatric studies were excluded. A random-effects NMA was performed, with efficacy measured as Mean Difference (MD) and treatments ranked using Surface Under the Cumulative Ranking Curve (SUCRA), where a lower SUCRA value indicates better efficacy.

Results The analysis included multiple antidepressants assessed on the Hamilton Depression Scale (HDS) and Hamilton Anxiety Rating Scale (Ham-A). For HDS at 4 weeks and 8 weeks, and for Ham-A at 1 week and 6 weeks, duloxetine consistently ranked first (SUCRA range: 0.071–0.084). Escitalopram was the second-most efficacious for HDS at 8 weeks (SUCRA=0.481) and ranked first for Ham-A at 1 week (SUCRA=0.153). In a separate three-treatment analysis for HDS at 3 months, nortriptyline was most efficacious (SUCRA=0.084), followed by placebo and fluoxetine. Citalopram and sertraline generally ranked lower across outcomes.

Conclusions Duloxetine and escitalopram demonstrate superior efficacy for both depressive and anxiety symptoms in PSD in the short-to-medium term, while nortriptyline appears highly effective for depression at 3 months. These findings can guide clinical decision-making for antidepressant selection in PSD management.

Authors/Disclosures
Abdullah Serhan, MD PRESENTER	Dr. Serhan has nothing to disclose.
AlBaraa K. Mohammad, MD, Medical student	Mr. Mohammad has nothing to disclose.
Bara M. Hammadeh	Mr. Hammadeh has nothing to disclose.
Raneem A. Araydah, Medical Student	Dr. Araydah has nothing to disclose.
Asmaa K. Mohammad, Medical student	Miss Mohammad has nothing to disclose.
Bashar Shaban, MD	Dr. Shaban has nothing to disclose.
Tala S. Awed, MD	Miss Awed has nothing to disclose.
Nagham A. Shehadeh, MD	Dr. Shehadeh has nothing to disclose.
HISHAM ABD ULNOUR, MD	Dr. ABD ULNOUR has nothing to disclose.