Chen Yan, Patel Nick C, Guo Jeff J, Zhan Siyan
Pharmacoepidemiology and Pharmacoeconomics, Division of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of Cincinnati Medical Center, Cincinnati, Ohio 45267-0004, USA.
Int Clin Psychopharmacol. 2007 May;22(3):159-66. doi: 10.1097/YIC.0b013e32807fb028.
Given the high incidence of poststroke depression, its serious sequelae, and inherent problems with diagnosis, prophylactic use of antidepressants may be a viable management strategy in patients experiencing stroke. The purpose of this study was to assess the prophylactic effects of antidepressants in nondepressed patients with stroke. A meta-analysis of randomized placebo-controlled trials evaluating the prophylactic effects of antidepressants in nondepressed patients with stroke was conducted. Literature searches in MEDLINE, PubMed, CINAHL, PsycINFO, EMBASE, Cochrane library, and CNKI from 1950 to August 2006 were used to identify the relevant studies. Outcome measures included the occurrence rate of newly developed poststroke depression cases and severity of depressive symptoms as indicated by mean depression rating scale scores. The effect size was presented as rate difference or weighted mean difference. From 10 randomized clinical trials, a total of 703 nondepressed patients after stroke were identified. The pooled occurrence rate of newly developed poststroke depression cases in the intervention and control groups were 12.54 (41/327) and 29.17% (91/312), respectively (pooled rate difference=-0.17, 95% confidence interval: -0.26 to -0.08). Prophylactic effects of antidepressants were not related to duration of use {coefficient of Pearson's correlation [gamma]=0.57, P=0.11}. In conclusion, antidepressant prophylaxis is associated with a significant reduction in the occurrence rate of newly developed poststroke depression, suggesting antidepressants may be considered along with other vascular preventive strategies in the management of stroke patients.
鉴于中风后抑郁症的高发病率、其严重的后遗症以及诊断中存在的固有问题，对于中风患者，预防性使用抗抑郁药可能是一种可行的治疗策略。本研究的目的是评估抗抑郁药对无抑郁症的中风患者的预防作用。我们对评估抗抑郁药对无抑郁症的中风患者预防作用的随机安慰剂对照试验进行了荟萃分析。利用1950年至2006年8月期间在MEDLINE、PubMed、CINAHL、PsycINFO、EMBASE、Cochrane图书馆和中国知网进行的文献检索来识别相关研究。结局指标包括新发生的中风后抑郁症病例的发生率以及抑郁症状的严重程度（以平均抑郁评定量表分数表示）。效应量以率差或加权均差表示。从10项随机临床试验中，共确定了703例中风后无抑郁症的患者。干预组和对照组中新发生的中风后抑郁症病例的合并发生率分别为12.54%（41/327）和29.17%（91/312）（合并率差=-0.17，95%置信区间：-0.26至-0.08）。抗抑郁药的预防作用与使用持续时间无关（Pearson相关系数[γ]=0.57，P=0.11）。总之，抗抑郁药预防与新发生的中风后抑郁症发生率的显著降低相关，这表明在中风患者的管理中，抗抑郁药可与其他血管预防策略一起考虑。
