Association of depression and SSRIs with mortality after stroke

In both early and late stages of stroke course, depression remains a common comorbid condition lacking well-defined clinical, social, or demographic predictors.(1) According to a recent meta-analysis, the prevalence of depression among people who had a stroke was 29% (from 25% to 32%), remaining stable up to 10 years after stroke.(2) Despite a large body of literature published in this field, uncertainties on outcome and health consequences linger. Although a systematic review and meta-analysis involving 59,598 individuals from 13 studies reported an association between depression after stroke and mortality,(3) the high level of heterogeneity across the included studies in terms of study design, follow-up duration, source of recruitment, and time or methods of depression assessment limits interpretability of these findings. On the other hand, another meta-analysis found prestroke depression was associated with a pooled higher risk (hazard ratio 1.55; 95% confidence interval 1.25-1.93) of fatal stroke.(4) However, routine use of antidepressants after stroke remains controversial, due to the heterogeneity and methodologic limitations of pharmacologic trials published in this field.(5