Are they necessary? Preventive therapies for post-stroke depression: a meta-analysis of RCTs
Abstract
To explore the necessity and feasibility of early anti-depressive therapies in acute stroke patients, we conducted a meta-analysis of currently available randomized control studies (RCTs). Literature search in six databases was done with keywords of cerebrovascular accident, depression and prevention. Only RCTs that met the inclusion criteria were enrolled for further analysis. Twelve eligible studies were included in this meta-analysis. Prophylactic anti-depressive therapies following acute stroke were shown to reduce the incidence of depression in the patients (RR = =0.33, 95% CI: 0.25 to 0.43, p < 0.001), improve symptoms of depression (WMD: 5.73, 95% CI: 4.18 to 7.29, p < 0.001), improve motor function (WMD: 12.56, 95%CI: 9.07 to 16.04, p < 0.001) and neurological function (WMD: 1.13, 95%CI: 0.57 to 1.69, p < 0.001). However, anti-depressive therapies showed no effects on mortality (RR = 1.63, 95%CI: 0.55 to 4.85, p = 0.377) and adverse events incidence (RR = 0.93, 95%CI: 0.53 to 1.64, p = 0.806). Anti-depressive therapies following acute stroke is effective thus deserves to be advocated.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Nine out of 10 reviews of depression prevention trials in children and adolescents report significant reductions in depressive symptoms, generally with small effect sizes.
“Nine out of 10 reviews of these trials report significant reductions in depressive symptoms, 428-436 generally with small effect sizes.”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [431]
Four reviews analysed the incidence of depressive disorders as an outcome, and all reported reductions in incidence.
“Four reviews analysed the incidence of depressive disorders as an outcome, and all reported reductions in incidence. 430-432”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [431]
A large meta-analysis focused solely on school-based CBT detected small effects for depression prevention in the short- and medium-terms, with a small long-term benefit.
“A large meta-analysis focused solely on schoolbased CBT detected small effects for depression prevention in the short- and medium-terms, with a small long-term benefit. 431”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [431]
Cites
Measuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139 · see citing works
Assessing the quality of reports of randomized clinical trials: Is blinding necessary?
Jadad, A. R., Moore, R. A., Carroll, D., Jenkinson, C., Reynolds, D. J. M., Gavaghan, D. J., & McQuay, H. J. (1996) · Controlled Clinical Trials · doi:10.1016/0197-2456(95)00134-4 · Cited by 17,582 · see citing works
Heart disease and stroke statistics-2018 update: a report from the american heart association
Benjamin, E. J., Virani, S. S., Callaway, C. W., Chamberlain, A. M., Chang, A. R., Cheng, S., Chiuve, S. E., Cushman, M., Delling, F. N., Deo, R., et al. (2018) · Circulation · doi:10.1161/cir.0000000000000558 · Cited by 7,146 · see citing works
Gluud, L. L., Villumsen, J., & Gluud, C. N. (2001) · Annals of Internal Medicine · doi:10.7326/0003-4819-135-11-200112040-00010 · Cited by 2,262 · see citing works
Investigating and dealing with publication and other biases in meta-analysis
Sterne, J. A. C., Egger, M., & Smith, G. D. (2001) · BMJ · doi:10.1136/bmj.323.7304.101 · Cited by 2,225 · see citing works
Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990-2013: The GBD 2013 Study
Feigin, V. L., Krishnamurthi, R., Parmar, P. G. K., Norrving, B., Mensah, G. A., Bennett, D., Barker-Collo, S. L., Moran, A. E., Sacco, R. L., Truelsen, T., et al. (2015) · Neuroepidemiology · doi:10.1159/000441085 · Cited by 1,313 · see citing works
Ayerbe, L., Ayis, S., Wolfe, C. D. A., & Rudd, A. G. (2013) · British Journal of Psychiatry · doi:10.1192/bjp.bp.111.107664 · Cited by 980 · see citing works
Chollet, F., Tardy, J., Albucher, J.-F., Thalamas, C., Berard, E., Lamy, C., Bejot, Y., Deltour, S., Jaillard, A., Niclot, P., et al. (2011) · The Lancet Neurology · doi:10.1016/s1474-4422(10)70314-8 · Cited by 925 · see citing works
Towfighi, A., Ovbiagele, B. I., Husseini, N. E., Hackett, M. L., Jorge, R. E., D, B. M. K. M., Mitchell, P. H., Skolarus, L. E., Whooley, M. A., & Williams, L. S. (2016) · Stroke · doi:10.1161/str.0000000000000113 · Cited by 783 · see citing works
Post-stroke depression: Mechanisms and pharmacological treatment
Villa, R. F., Ferrari, F., & Moretti, A. (2017) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2017.11.005 · Cited by 537 · see citing works
Cai, W., Mueller, C., Li, Y.-J., Shen, W.-D., & Stewart, R. (2019) · Ageing Research Reviews · doi:10.1016/j.arr.2019.01.013 · Cited by 359 · see citing works
Escitalopram and Problem-Solving Therapy for Prevention of Poststroke Depression
Robinson, R. G., Jorge, R. E., Moser, D. J., Ación, L., Solodkin, A., Small, S. L., Fonzetti, P., Hegel, M. T., & Arndt, S. V. (2008) · JAMA · doi:10.1001/jama.299.20.2391 · Cited by 355 · see citing works
Post stroke depression: the sequelae of cerebral stroke
Das, J., & G.K., R. (2018) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2018.04.005 · Cited by 301 · see citing works
Dennis, M. S., Mead, G. E., Forbes, J., Graham, C., Hackett, M. L., Hankey, G. J., House, A. O., Lewis, S. C., Lundström, E., Sandercock, P. A., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(18)32823-x · Cited by 288 · see citing works
Risk Factors for Post-stroke Depression: A Meta-analysis
Shi, Y., Yang, D.-D., Zeng, Y.-Y., & Wu, W. (2017) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2017.00218 · Cited by 269 · see citing works
The Natural History of Depression up to 15 Years After Stroke
Ayerbe, L., Ayis, S. A., Crichton, S. L., Wolfe, C. D. A., & Rudd, A. G. (2013) · Stroke · doi:10.1161/strokeaha.111.679340 · Cited by 206 · see citing works
Rasmussen, A., Lunde, M., Poulsen, D. L., Sørensen, K., Qvitzau, S., & Bech, P. (2003) · Psychosomatics · doi:10.1176/appi.psy.44.3.216 · Cited by 196 · see citing works
Pharmacological treatment of unipolar depressive disorders: summary of WFSBP guidelines
Bauer, M., Severus, E., Möller, H.-J., Young, A. H., & WFSBP Task Force on Unipolar Depressive Disorders (2017) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/13651501.2017.1306082 · Cited by 175 · see citing works
Renoux, C., Vahey, S., Dell’Aniello, S., & Boivin, J. (2016) · JAMA Neurology · doi:10.1001/jamaneurol.2016.4529 · Cited by 136 · see citing works
Early Post-stroke Depression and Mortality: Meta-Analysis and Meta-Regression
Bartoli, F., Brita, C. D., Crocamo, C., Clerici, M., & Carrà, G. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00530 · Cited by 134 · see citing works
Narushima, K., Kosier, J. T., & ROBINSON, R. G. (2002) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-200205000-00005 · Cited by 120 · see citing works
Kim, J. S., Lee, E.-J., Chang, D.-I., Park, J. H., Sj, A., Jk, C., Heo, J. H., Sohn, S.-I., Lee, B., Kim, H. Y., et al. (2016) · The Lancet Psychiatry · doi:10.1016/s2215-0366(16)30417-5 · Cited by 111 · see citing works
Selective Serotonin Reuptake Inhibitors
Lochmann, D., & Richardson, T. (2018) · Handbook of experimental pharmacology · doi:10.1007/164_2018_172 · Cited by 106 · see citing works
Low serum BDNF may indicate the development of PSD in patients with acute ischemic stroke
Yang, L., Zhang, Z., Sun, D., Xu, Z., Yuan, Y., Zhang, X., & Li, L. (2010) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.2552 · Cited by 89 · see citing works
Preventing Depression After Stroke
Almeida, O. P., Waterreus, A. J., & Hankey, G. J. (2006) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v67n0713 · Cited by 88 · see citing works
Gluud, L. L., Thorlund, K., Gluud, C. N., Woods, L., Harris, R., & Sterne, J. A. C. (2008) · Annals of Internal Medicine · doi:10.7326/0003-4819-149-3-200808050-00023 · Cited by 85 · see citing works
Diversiform Etiologies for Post-stroke Depression
Wang, Z., Shi, Y., Liu, F., Jia, N., Gao, J., Pang, X., & Deng, F. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00761 · Cited by 81 · see citing works
High platelet-to-lymphocyte ratio are associated with post-stroke depression
Huang, G., Chen, H., Wang, Q., Hong, X., Hu, P., Xiao, M., Shu, M., & He, J. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.12.012 · Cited by 78 · see citing works
Self-citationRates and correlates of suicidal ideation among stroke survivors: a meta-analysis
Bartoli, F., Pompili, M., Lillia, N., Crocamo, C., Salemi, G., Clerici, M., & Carrà, G. (2017) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2017-315660 · Cited by 76 · see citing works
Serotonin Reuptake Inhibitors and Risk of Abnormal Bleeding
Andrade, C., & Sharma, E. (2016) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2016.04.010 · Cited by 72 · see citing works
Depression predictors within six months of ischemic stroke: The DEPRESS Study
Guiraud, V., Gallarda, T., Calvet, D., Turc, G., Oppenheim, C., Rouillon, F., & Mas, J. (2016) · International Journal of Stroke · doi:10.1177/1747493016632257 · Cited by 67 · see citing works
Tseng, P., Cheng, Y., Chen, Y., Wu, C.-K., & Lin, P. (2015) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2015.06.001 · Cited by 63 · see citing works
Espinera, A. R., Ogle, M. E., Gu, X., & Li, W. (2013) · Neuroscience · doi:10.1016/j.neuroscience.2013.04.011 · Cited by 60 · see citing works
Malondialdehyde: A novel predictive biomarker for post-stroke depression.
Liu, Z.-H., Zhu, Z., Zhao, J.-Y., Ren, W.-W., Cai, Y., Wang, Q.-Z., Luan, X., Zhao, K., & He, J.-C. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.05.023 · Cited by 57 · see citing works
Chatterjee, K., Fall, S., & Barer, D. H. (2010) · BMC Neurology · doi:10.1186/1471-2377-10-125 · Cited by 46 · see citing works
Grzeskowiak, L. E., McBain, R. D., Dekker, G., & Clifton, V. L. (2015) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.13612 · Cited by 45 · see citing works
Prevention of Poststroke Apathy Using Escitalopram or Problem-Solving Therapy
Mikami, K., Jorge, R. E., Moser, D. J., Arndt, S. V., Jang, M., Solodkin, A., Small, S. L., Fonzetti, P., Hegel, M. T., & Robinson, R. G. (2013) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2012.07.003 · Cited by 44 · see citing works
Prevention of poststroke depression with milnacipran in patients with acute ischemic stroke
Tsai, C., Wu, C.-L., Chou, S., Tsang, H., Hung, T., & Su, J. (2011) · International Clinical Psychopharmacology · doi:10.1097/yic.0b013e32834a5c64 · Cited by 43 · see citing works
Nondysphoric Depression Following Stroke
Paradiso, S., Vaidya, J. G., Tranel, D., Kosier, T., & Robinson, R. G. (2008) · Journal of Neuropsychiatry · doi:10.1176/jnp.2008.20.1.52 · Cited by 38 · see citing works
Prophylactic Effects of Duloxetine on Post-Stroke Depression Symptoms: An Open Single-Blind Trial
Zhang, L., Hu, X., Yao, L.-Y., Geng, Y., Wei, L.-L., Zhang, J., & Chen, W. (2013) · European Neurology · doi:10.1159/000345374 · Cited by 37 · see citing works
White matter hyperintensities in post-stroke depression: a case control study
Tang, W. K., Chen, Y., Lu, J., Chu, C. W., Mok, V., Ungvari, G. S., & Wong, K. S. (2010) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.2009.203141 · Cited by 35 · see citing works
Yin, J., Zhong, C., Zhu, Z., Bu, X., Xu, T., Guo, L., Wang, X., Zhang, J., Cui, Y., Li, D., et al. (2018) · Clinica Chimica Acta · doi:10.1016/j.cca.2018.01.011 · Cited by 35 · see citing works
Two novel, putative mechanisms of action for citalopram-induced platelet inhibition
Roweth, H. G., Cook, A. A., Moroi, M., Bonna, A., Jung, S. M., Bergmeier, W., Sage, S. O., & Jarvis, G. E. (2018) · Scientific Reports · doi:10.1038/s41598-018-34389-5 · Cited by 21 · see citing works
López-Vílchez, I., Jerez, D., Díaz‐Ricart, M., Navarro, V., Zafar, M. U., Zamorano‐León, J. J., López-Farré, A. J., Badimón, J. J., Gastó, C., & Escolar, G. (2017) · Thrombosis and Haemostasis · doi:10.1160/th17-04-0288 · Cited by 17 · see citing works
Yue, Y., Jiang, H., Liu, R., Yin, Y., Zhang, Y., Liang, J., Li, S., Wang, J., Lü, J., Geng, D., et al. (2016) · Oncotarget · doi:10.18632/oncotarget.11105 · Cited by 15 · see citing works
Lu, R.-C., Miao, D., & Tan, L. (2010) · Chin J Neurol · doi:10.3760/cma.j.issn.1006-7876.2010.05.011 · Cited by 3 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Time for united action on depression: a Lancet–World Psychiatric Association Commission
Herrman, H., Patel, V., Kieling, C., Berk, M., Buchweitz, C., Cuijpers, P., Furukawa, T. A., Kessler, R. C., Kohrt, B. A., Maj, M., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(21)02141-3 · Cited by 1,104 · see citing works
Post-stroke depression: A 2020 updated review
Medeiros, G. C., Roy, D., Kontos, N. J., & Beach, S. R. (2020) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2020.06.011 · Cited by 590 · see citing works
Efficacy and Safety of Antidepressants in Patients With Comorbid Depression and Medical Diseases
Köhler‐Forsberg, O., Stiglbauer, V., Brasanac, J., Chae, W. R., Wagener, F., Zimbalski, K., Jefsen, O. H., Liu, S., Seals, M. R., Gamradt, S., et al. (2023) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2023.2983 · Cited by 44 · see citing works
Primary prevention of depression: An umbrella review of controlled interventions
de Pablo, G. S., Solmi, M., Vaquerizo‐Serrano, J., Raduà, J., Passina, A., Mosillo, P., Correll, C. U., Borgwardt, S., Galderisi, S., Bechdolf, A., et al. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.07.101 · Cited by 40 · see citing works
Depressed Mood after Stroke: Predictive Factors at Six Months Follow-Up
López‐Espuela, F., Roncero‐Martín, R., Canal-Macías, M. L., Morán, J. M., Vera, V., Gómez-Luque, A., Mesa, A. L., Pedrera‐Zamorano, J. D., Naranjo, I. C., & García, J. M. L. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17249542 · Cited by 39 · see citing works
Preventive Approaches for Post-Stroke Depression: Where Do We Stand? A Systematic Review
Woranush, W., Moskopp, M. L., Sedghi, A., Stuckart, I., Noll, T., Barlinn, K., & Siepmann, T. (2021) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s337865 · Cited by 33 · see citing works
A comprehensive overview of post-stroke depression treatment options
Raggi, A., Serretti, A., & Ferri, R. (2023) · International Clinical Psychopharmacology · doi:10.1097/yic.0000000000000532 · Cited by 24 · see citing works
An updated review on prediction and preventive treatment of post-stroke depression
Sun, S., Li, Z.-F., Xiao, Q., Tan, S.-W., Hu, B., & Jin, H.-J. (2023) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2023.2234081 · Cited by 22 · see citing works
Developments in treating the nonmotor symptoms of stroke
Hillis, A. E. (2020) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2020.1763173 · Cited by 21 · see citing works
Zhou, Y., Zhao, L., Tang, Y., & Qian, S. (2025) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2025.112050 · Cited by 17 · see citing works
Establishment and verification of a nomogram model for predicting the risk of post-stroke depression
Luo, S., Zhang, W., Mao, R., Huang, X., Liu, F., Liao, Q., Sun, D., Chen, H., Zhang, J., & Tian, F. (2023) · PeerJ · doi:10.7717/peerj.14822 · Cited by 10 · see citing works
Richards, L. G., Ifejika, N. L., Stein, J., Bahouth, M. N., Saylor, M. A., Barrett, A. M., Chen, P., Deutsch, A. F., Dusenbury, W., Ellis, C., et al. (2026) · Stroke · doi:10.1161/str.0000000000000536 · Cited by 8 · see citing works
Risk factors and ambulatory outcome in ischemic stroke patients with pre-stroke depression
Okon, M., Blum, B., & Nathaniel, T. I. (2021) · Journal of Vascular Nursing · doi:10.1016/j.jvn.2021.07.004 · Cited by 5 · see citing works
A Pilot Study of Remote Ischemic Conditioning in Preventing Post-Stroke Depression
Li, W., Qin, Y., Wang, J., Li, L., Gao, J., Xu, X., Wu, Z., Ji, X., Wang, Y., Gao, K., et al. (2025) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s495215 · Cited by 4 · see citing works
Preventive intervention for depression in children, adolescents and adults
Disciplina Medicină de familie, U. D. M. Ș. F. „. D., Stănescu, A. M. A., SIMIONESCU, A. A., Disciplina Obstetrică-Ginecologie, Grăjdeanu, I. V., Disciplina Medicină de familie, U. D. M. Ș. F. „. H., Florea, M., & Disciplina Medicină de familie, U. D. M. Ș. F. „. H. (2021) · Romanian Journal of Medical Practice · doi:10.37897/rjmp.2021.s4.13 · Cited by 2 · see citing works
Ferrario, I., & Négrini, S. (2021) · Neurorehabilitation · doi:10.3233/nre-218006 · Cited by 1 · see citing works
Campion, J. (2022) · Oxford University Press eBooks · doi:10.1093/med/9780198861478.003.0051
- Authors
- Gu, J., Huang, H., Chen, K., Huang, G., Huang, Y., & Xu, H.
- Affiliations
- Shantou University (CN)
- Corresponding author
- Xu, Hongwu
- Venue
- Psychiatry Research
- Publisher
- Elsevier BV
- Published
- 2020-02
- Volume
- 284
- Pages
- 112670
- ISSN
- 0165-1781 (ISSN-L)
- OpenAlex
- W2983974405
- Cited by
- 24
- References
- 46
- Citations by year
- 2026: 1 · 2025: 2 · 2023: 11 · 2022: 2 · 2021: 5 · 2020: 3
- FWCI
- 0.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Psychiatry Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Guangdong Medical Research Foundation (A2019392)
- Topics
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- post-stroke depression, acute stroke, depression prevention, motor recovery, neurological function, mortality, adverse events
- MeSH terms
- Stroke Rehabilitation, Adult, Aged, Antidepressive Agents, Depression, Female, Humans, Male, Middle Aged, Incidence, Randomized Controlled Trials as Topic, Stroke
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
