Abstract
Objective : To determine whether antidepressants that differ in their monoamine re uptake inhibitory effects—desipramine (noradrenergic), trazodone (relatively sero tonergic), and fluoxetine (selectively serotonergic)—differentially affect recovery from stroke associated with depression.
Background: Animal models and limited studies in man show that noradrener gic agents enhance sensorimotor and visual recovery after brain injury, whereas sero tonergic agents impede such recovery.
Methods: Twenty-four stroke rehabilitation inpatients meeting DSM3R crite ria for organic mood disorder with depression were randomized to receive desipramine (N = 13), trazodone (N= 6), or fluoxetine (N = 5). The initial and target doses of desipramine were 50 mg and 100 mg, respectively, fluoxetine, 10 mg and 20 mg, and trazodone, 50 mg and 100 mg.
Results: The age, sex, interval post stroke, type and location of stroke, type of neurologic deficit, severity of depression (Hamilton Depression Scale [HDS]), func tional disability (Functional Independence Measure [FIM]), and neurologic impair ment (Fugl-Meyer Scale [F-M]) at baseline were comparable for the three treatment groups. Eighteen patients completed four weeks of study. Treatment was discontinued because of possible side effects in six patients, five of whom were taking desipramine. Patients in the trazodone and fluoxetine groups had significantly greater gain in FIM than patients in the desipramine group both at two weeks and at four weeks (p < 0.05). F-M and HDS scores improved equally among the three groups.
Conclusions: Serotonergic agents were associated with better functional recov ery and fewer side effects. Noradrenergic and serotonergic agents were equally effec tive in treating depression following stroke.