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