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Escitalopram, Problem-Solving Therapy, and Poststroke Depression

Alice Rasmussen, MD; Jamal A. Hanash, MD; Per Bech, MD
JAMA. 2008;300(15):1757-1759. doi:10.1001/jama.300.15.1758-a.
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To the Editor: In a randomized, placebo-controlled trial of the preventive use of the SSRI escitalopram in poststroke depression, Dr Robinson and colleagues1 classified the study by Rasmussen et al2 in the group of trials that have failed to show a significant effect of SSRIs over placebo in preventing poststroke depression. This is not correct.

The study by Rasmussen et al2 used the 6 depressive core items3,4 on the HDRS. It demonstrated that the rate of clinical depression (a cutoff score of 9 or more on the 6-item HDRS subscale) was 28.1% for placebo and 11.5% for the SSRI sertraline over an observation period of 1 year (P = .02). Taking into account that the study by Robinson et al1 used a rather low cutoff score on the 17-item HDRS, our results are similar. Robinson et al demonstrated that the rate of depression was 22.4% for placebo and 8.5% for escitalopram in patients with recent stroke.

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October 15, 2008
Olaf Schulte-Herbrüggen, MD; Stefan Röpke, MD
JAMA. 2008;300(15):1757-1759. doi:10.1001/jama.300.15.1757-a.
October 15, 2008
Michael Dettling, MD; Carolin Opgen-Rhein, MD; Ion Anghelescu, MD
JAMA. 2008;300(15):1757-1759. doi:10.1001/jama.300.15.1757-b.
October 15, 2008
Jeffrey Lacasse, PhD; Jonathan Leo, PhD
JAMA. 2008;300(15):1757-1759. doi:10.1001/jama.300.15.1757-c.
October 15, 2008
Robert G. Robinson, MD; Ricardo E. Jorge, MD; Stephan Arndt, PhD
JAMA. 2008;300(15):1757-1759. doi:10.1001/jama.300.15.1758-b.
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