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To the Editor: The study of prevention of poststroke depression by Dr Robinson and colleagues¹ showed modest clinical effects of the SSRI escitalopram given over 12 months compared with placebo and problem-solving therapy. However, comparing the design of this study and its positive results with another poststroke depression study of the same group with negative results² raises important questions.

First, inclusion criteria for diagnosis of depressive episode differed between each study, from having an HDRS-17 score 11 or lower¹ to having a score 18 or greater²; this resulted in mean baseline scores of 7¹ vs 22.²

Second, an item-by-item analysis of the HDRS-17 was not conducted in the preventive SSRI study. This is of concern because it is unlikely that hemispheric, brainstem, or cerebellar stroke with their different neurological outcomes would produce an identical depressive syndrome for specific items such as depressive cognition and thoughts, suicidal ideation, and vegetative . . . [Full Text of this Article]

Michael Dettling, MD
michael.dettling@charite.de

Carolin Opgen-Rhein, MD; Ion Anghelescu, MD
Department of Psychiatry and Psychotherapy
Charité–University Medicine Berlin
Berlin, Germany

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