J Stroke.  2018 May;20(2):258-267. 10.5853/jos.2017.02712.

Differences in Therapeutic Responses and Factors Affecting Post-Stroke Depression at a Later Stage According to Baseline Depression

  • 1Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. jongskim@amc.seoul.kr
  • 2Department of Neurology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea.
  • 3Department of Neurology, Myongji Hospital, Goyang, Korea.
  • 4Department of Neurology, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea.
  • 5Department of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea.
  • 6Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 7Department of Neurology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
  • 8Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
  • 9Department of Neurology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea.
  • 10Department of Neurology, Konkuk University School of Medicine, Seoul, Korea.
  • 11Department of Neurology, Kangwon National University School of Medicine, Chuncheon, Korea.
  • 12Department of Neurology, Korea University Asan Hospital, Korea University College of Medicine, Asan, Korea.
  • 13Department of Neurology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea.
  • 14Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 15Department of Neurology, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea.
  • 16Department of Neurology, Daegu Fatima Hospital, Daegu, Korea.
  • 17Department of Neurology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
  • 18Department of Psychiatry, Hyundai Hospital, Eumseong, Korea.
  • 19The Research Institute of Nursing Science, Seoul National University College of Nursing, Seoul, Korea.
  • 20College of Medicine, Michigan State University, East Lansing, MI, USA.
  • 21Clinical Research Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.


The pathophysiology of post-stroke depression (PSD) is complex and may differ according to an individual's mood immediately after stroke. Here, we compared the therapeutic response and clinical characteristics of PSD at a later stage between patients with and without depression immediately after stroke.
This study involved a post hoc analysis of data from EMOTION (ClinicalTrials.gov NCT01278498), a placebo-controlled, double-blind trial that examined the efficacy of escitalopram (10 mg/day) on PSD and other emotional disturbances among 478 patients with acute stroke. Participants were classified into the Baseline-Blue (patients with baseline depression at the time of randomization, defined per the Montgomery-Asberg Depression Rating Scale [MADRS] ≥8) or the Baseline-Pink groups (patients without baseline depression). We compared the efficacy of escitalopram and predictors of 3-month PSD (MADRS ≥8) between these groups.
There were 203 Baseline-Pink and 275 Baseline-Blue patients. The efficacy of escitalopram in reducing PSD risk was more pronounced in the Baseline-Pink than in the Baseline-Blue group (p for interaction=0.058). Several risk factors differentially affected PSD development based on the presence of baseline depression (p for interaction < 0.10). Cognitive dysfunction was an independent predictor of PSD in the Baseline-Blue, but not in the Baseline-Pink group, whereas the non-use of escitalopram and being female were more strongly associated with PSD in the Baseline-Pink group.
Responses to escitalopram and predictors of PSD 3 months following stroke differed based on the presence of baseline depression. Our data suggest that PSD pathophysiology is heterogeneous; therefore, different therapeutic strategies may be needed to prevent PSD emergence following stroke.


Depression; Stroke; Escitalopram; Anger; Emotional incontinence

MeSH Terms

Affective Symptoms
Random Allocation
Risk Factors
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