Article

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 (PMES = 0.02,
PHAMD17 = 0.02) in the group
recruited six months after discharge and between Groups
A and C (PMES = 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.

Langue : ANGLAIS