Objective:

To rank antidepressants based on their efficacy in reducing depressive and anxiety symptoms in patients with PSD, using standardized rating scales over multiple time points.

Background:

Post-stroke depression (PSD) is a common complication, yet the comparative efficacy of antidepressants remains uncertain. This network meta-analysis (NMA) aimed to evaluate the relative efficacy of pharmacological interventions for PSD.

Design/Methods:

A systematic search was conducted for randomized controlled trials (RCTs) involving adults diagnosed with PSD via DSM criteria. Pediatric studies were excluded. A random-effects NMA was performed, with efficacy measured as Mean Difference (MD) and treatments ranked using Surface Under the Cumulative Ranking Curve (SUCRA), where a lower SUCRA value indicates better efficacy.

Results:

The analysis included multiple antidepressants assessed on the Hamilton Depression Scale (HDS) and Hamilton Anxiety Rating Scale (Ham-A). For HDS at 4 weeks and 8 weeks, and for Ham-A at 1 week and 6 weeks, duloxetine consistently ranked first (SUCRA range: 0.071–0.084). Escitalopram was the second-most efficacious for HDS at 8 weeks (SUCRA=0.481) and ranked first for Ham-A at 1 week (SUCRA=0.153). In a separate three-treatment analysis for HDS at 3 months, nortriptyline was most efficacious (SUCRA=0.084), followed by placebo and fluoxetine. Citalopram and sertraline generally ranked lower across outcomes.

Conclusions:

Duloxetine and escitalopram demonstrate superior efficacy for both depressive and anxiety symptoms in PSD in the short-to-medium term, while nortriptyline appears highly effective for depression at 3 months. These findings can guide clinical decision-making for antidepressant selection in PSD management.