Prevention of Poststroke Apathy Using Escitalopram or Problem-Solving Therapy

• Published in: The American journal of geriatric psychiatry Vol. 21; no. 9; pp. 855 - 862
• Main Authors: Mikami, Katsunaka, M.D., Ph.D, Jorge, Ricardo E., M.D, Moser, David J., Ph.D, Arndt, Stephan, Ph.D, Jang, Mijin, M.S, Solodkin, Ana, Ph.D, Small, Steven L., M.D., Ph.D, Fonzetti, Pasquale, M.D, Hegel, Mark T., Ph.D, Robinson, Robert G., M.D
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01-09-2013
• Subjects: Aged; Antidepressive Agents, Second-Generation - therapeutic use; Apathy; Citalopram - therapeutic use; Female; Humans; Internal Medicine; Male; Mental Disorders - complications; Mental Disorders - prevention & control; Mental Disorders - psychology; Middle Aged; prevention; Proportional Hazards Models; Psychotherapy - methods; stroke; Stroke - complications; Stroke - psychology; Treatment Outcome; Apathy; stroke; prevention
• ISSN: 1064-7481; 1545-7214
• DOI: 10.1016/j.jagp.2012.07.003

Objective Apathy occurs frequently following stroke and prior studies have demonstrated the negative effect of apathy on recovery from stroke. This study was a secondary analysis examining the efficacy of escitalopram, problem-solving therapy (PST), or placebo administered for 1 year to prevent the onset of apathy among patients with recent stroke. Methods Patients within 3 months of an index stroke who did not meet DSM-IV diagnostic criteria for major or minor depression and who did not have a serious comorbid physical illness were enrolled. Patients were recruited from three sites: University of Iowa, University of Chicago, and Burke Rehabilitation Hospital. One hundred fifty-four patients without evidence of apathy at initial evaluation were included in the randomized controlled trial using escitalopram (10 mg patients ≤65 years; 5 mg patients >65 years) (N = 51) or placebo (N = 47) or non-blinded PST (12 total sessions) (N = 56) over 1 year. At 3, 6, 9, and 12 months, patients were assessed for diagnosis and severity of apathy using the Apathy Scale. Results Using a Cox proportional hazards model of time to onset of apathy, participants given placebo were 3.47 times more likely to develop apathy than patients given escitalopram and 1.84 times more likely to develop apathy than patients given PST after controlling for age, sex, cognitive impairment, and diabetes mellitus status (adjusted hazard ratio: 3.47, 95% CI: 1.79–6.73 [escitalopram group]; adjusted hazard ratio: 1.84, 95% CI: 1.21–2.80 [PST group]). Conclusion Escitalopram or PST was significantly more effective in preventing new onset of apathy following stroke compared with placebo.