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| |  Escitalopram May Improve Cognitive Function After Stroke CHICAGO -- February 1, 2010 -- Patients who received the antidepressant escitalopram following a stroke appear to recover more of their thinking, learning, and memory skills than those taking placebo or participating in problem-solving therapy, according to a study published in the February issue of Archives of General Psychiatry. “… Besides the efforts currently undertaken to increase the number of patients treated with thrombolytic agents, there is growing interest in restorative therapies that can be administered during the first few months after stroke, the period within which we observe the greatest degree of spontaneous recovery of initial motor and cognitive deficits,” the authors wrote. One line of research has focused on antidepressants, which may be effective in part because of their ability to stimulate production of compounds essential for nerve cell growth. Ricardo E. Jorge, MD, University of Iowa, Iowa City, Iowa, and colleagues studied the effects of escitalopram among 129 stroke patients. Within 3 months of their stroke, 43 patients were randomly assigned to take 5 to 10 mg of escitalopram daily, 45 to take a placebo daily, and 41 to participate in a problem-solving therapy program developed for treating patients with depression. After 12 weeks of treatment, patients taking escitalopram had higher scores on neuropsychological tests assessing overall cognitive function and on those measuring verbal and visual memory. “Importantly, the reported changes in neuropsychological performance resulted in an improvement in related activities of daily living,” the authors wrote. “The beneficial effect of escitalopram on cognitive recovery was independent of its effect on depressive symptoms and was not influenced by stroke type or mechanism of ischaemic stroke,” they continued. “In addition, escitalopram was well tolerated and the frequency of adverse effects related to its administration was not different than that observed among patients receiving placebo.” Increasing evidence suggests that antidepressants cause changes in brain structure, including the visual cortex, hippocampus, and cerebral cortex. These structural changes, although not yet proven to affect behavioural performance, may underlie the improvements in verbal and visual memory observed in this trial, the authors noted. “Overall, whatever may be the mechanism of improved cognitive recovery, this study has shown, for the first time, that escitalopram is associated with improved cognitive recovery following stroke compared with placebo and Problem-Solving Therapy,” they concluded. “The utility of antidepressants in the process of post-stroke recovery deserves to be further investigated.”
SOURCE: Archives of General Psychiatry
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