This study found that non-depressed stroke patients, who discontinued escitalopram after 12 months, were more likely to develop major depression and increased HDRS scores during the next 6 months than patients given placebo or PST.
This study is limited by not including acute stroke patients such as those with severe co-morbid illness. Furthermore, the number of new major depressions were relatively small. Thus, our findings should be considered preliminary.
For clinicians, the most important implication of our finding is that patients, given antidepressants following stroke, may be more prone to develop depressive symptoms than untreated patients once their antidepressants are stopped. They may need to be monitored for depression for at least 6 months. Furthermore, treatment for longer than 1 year may be needed or slow tapering of antidepressants. Since PST effectively prevented poststroke depression and no new depressions occurred after cessation, should PST be the first treatment? Perhaps, but the lack of general availability of PST and administration of 12 therapy sessions will probably limit its use.
Cessation of escitalopram may have led to increased depressive symptoms because drugs like escitalopram produce changes in enzymes involved in synthesis and metabolism of biogenic amines and receptors and neuroplastic changes in hippocampus and prefrontal cortex.6, 7
Abrupt withdrawal of escitalopram may have led to neural system dysfunction and depression. Increased depressive symptoms after cessation of antidepressants has been reported in other studies. 8,9
It is important to remember that antidepressants may improve cognitive10
and physical recovery11