CITALOPRAM FOR POSTSTROKE PATHOLOGICAL CRYING

Post-stroke pathological crying is a distressing condition in which ep isodes occur in response to minor stimuli without associated mood chan ges. There is preliminary evidence of disturbed serotoninergic neurotr ansmission in such cases. We investigated the effect of the selective serotonin reuptake inhibitor citalopram on uncontrolled crying in stro ke patients in a double-blind placebo-controlled crossover study. 16 c onsecutive patients (median age 58.5 years, range 40-83) entered the 9 -week study a median of 168 days (range 6-913) post stroke and were tr eated with citalopram 10-20 mg daily for 3 weeks. Crying history was d etermined from semistructured interviews and from diaries kept by the patients. Psychiatric assessment was made with the Hamilton depression scale (HDS), and unwanted effects were measured with the UKU side-eff ect scale. In 13 patients in whom frequency of crying could be assesse d, the number of daily crying episodes decreased by at least 50% in al l cases during citalopram treatment vs 2 patients during placebo treat ment (p < 0.005, McNemar's test), the effect being rapid (1-3 days) an d pronounced in 11 (73%). There was a concomitant significant decrease in depression rating from HDS 8.9 to 5.3 (p < 0.005, Wilcoxon's test) . Citalopram was well tolerated, the few side-effects being mild and t ransient. We conclude that serotoninergic neurotransmission plays an i mportant part in post-stroke pathological crying and that citalopram i s an effective and well-tolerated treatment.