Feasibility and effectiveness of treatments for post-stroke depression in elderly inpatients: Systematic review

To determine the feasibility and effectiveness of antidepressive treatments for post-stroke depression in elderly medical inpatients, MEDLINE was sear ched for potentially relevant articles published from January 1987 to Augus t 1997 using the keywords "depression or depressive disorder" (exploded) an d "aged." Thirteen reports met the following inclusion criteria: (1) publis hed in English or French; (2) minimum age criterion of 55 and over or mean age 65 and over; (3) post-stroke subjects admitted to a medical, geriatric, or rehabilitation service; (4) used accepted criteria for depression; (5) examined treatment(s) for depression; and (6) reported outcomes as a depres sion diagnosis and/or symptom level. Data were abstracted independently fro m each article by two reviewers. The limited evidence suggests contraindica tions to treatment of 83% of a group to receive a heterocyclic antidepressa nt compared with 11% of a group to receive a selective serotonin reuptake i nhibitor (SSRI); rates of discontinuation and study completion are similar for heterocyclics, SSRIs and psychostimulants. All of the treatments appear to be at least modestly effective in the short term.