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To the Editor: The randomized controlled trial by Dr Robinson and colleagues¹ provided evidence that escitalopram can reduce the risk of poststroke depression over the first year after stroke. Apart from their antidepressive properties, selective serotonin reuptake inhibitors (SSRIs) have been shown to have neuroprotective function in animal models.^2-4 It would therefore be interesting to know whether the data in the study by Robinson et al suggest an additional neuroprotective effect of escitalopram, using outcomes such as reappearance of cerebral ischemia, degree of recovery from neurological deficits, or duration of physical rehabilitation needed after stroke.

To evaluate preventive effects of the 3 treatment groups for depression, it would also be helpful to look at the severity of depression (such as Hamilton Depression Rating Scale [HDRS] score after 1 year) in addition to the categorical analysis of whether diagnostic criteria for major or minor depression were fulfilled.

Financial Disclosures: None reported.

Olaf Schulte-Herbrüggen, MD
olaf.schulte-herbrueggen@charite.de

Stefan Röpke, MD
Department of Psychiatry and Psychotherapy
Charité–University Medicine Berlin
Berlin, Germany

1. Robinson RG, Jorge RE, Moser DJ; et al. Escitalopram and problem-solving therapy for prevention of poststroke depression: a randomized controlled trial. JAMA. 2008;299(20):2391-2400. FREE FULL TEXT 2. Duan W, Peng Q, Masuda N; et al. Sertraline slows disease progression and increases neurogenesis in N171-82Q mouse model of Huntington's disease. Neurobiol Dis. 2008;30(3):312-322. FULL TEXT | ISI | PUBMED 3. Sattin A, Pekary AE, Blood J. Escitalopram regulates expression of TRH and TRH-like peptides in rat brain and peripheral tissues. Neuroendocrinology. 2008;88(2):135-146. FULL TEXT | ISI | PUBMED 4. Peng Q, Masuda N, Jiang M; et al. The antidepressant sertraline improves the phenotype, promotes neurogenesis and increases BDNF levels in the R6/2 Huntington's disease mouse model. Exp Neurol. 2008;210(1):154-163. FULL TEXT | ISI | PUBMED

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2008;300(15):1757.

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Escitalopram and Problem-Solving Therapy for Prevention of Poststroke Depression: A Randomized Controlled Trial
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