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Don't Forget to Use Them After Stroke

An antidepressant improves memory in nondepressed poststroke patients.

Poststroke depression is common and responds to and can even be prevented by antidepressants, which can also improve motor and cognitive outcomes and activities of daily living. These researchers analyzed the effects of escitalopram on cognitive functioning in 129 stroke patients who had participated in a larger, 1-year study on the prevention of poststroke depression. Participants (age range, 50–90 years) were excluded if they had depression, a comprehension deficit, or impaired decision making. They were randomized within 3 months of stroke to receive escitalopram (10 mg), placebo, or problem-solving therapy.

After adjustment for covariates, including baseline scores and age, the escitalopram group showed significantly greater improvement at 1 year than the combined therapy–placebo group on tests of overall cognition, immediate memory, and delayed memory. Overall function and functional memory also improved more with escitalopram. No changes were seen in attention, language, visual-spatial/constructional, or executive functions.

Comment: SSRIs may have multiple neurophysiological effects, including hippocampal neurogenesis and neuroplasticity. Whether these effects are critical for antidepressant efficacy is unclear, but they might be responsible for the cognitive improvement demonstrated here. Apparently, the authors did not control for the effects on immediate memory when they analyzed changes in overall function and delayed memory. Since delayed memory is dependent on immediate memory (if you don't recall it right away, you won't remember it after 15 minutes), the overall results may be explained by the improvement in immediate memory.

Other studies suggest that noradrenergic drugs (amphetamines) and acetylcholinesterase inhibitors also improve poststroke recovery and cognition. A single study is needed to compare the nature and extent of improvement with each drug type. Considering the safety of SSRIs, they should be considered for treatment of all poststroke patients. In addition, their effect on recovery from other disorders, such as traumatic brain injury, should be explored.

— Jonathan Silver, MD

Published in Journal Watch Psychiatry February 22, 2010

Citation(s):

Jorge RE et al. Escitalopram and enhancement of cognitive recovery following stroke. Arch Gen Psychiatry 2010 Feb; 67:187.

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