Treatment with the antidepressant mirtazapine, started on the first day after an acute stroke, is “remarkably effective” in preventing the onset of Depression, results of a German trial suggest.

Depression often complicates recovery after a stroke, Dr. Isabella Heuser and colleagues note in their report in the Journal of Clinical Psychiatry.

Although there have been studies of preventative antidepressant treatment after stroke, results have been mixed, and none looked at beginning antidepressants immediately after the stroke.

Heuser, at Charite-University Medicine Berlin, and her associates randomly assigned 70 stroke patients to treatment with mirtazapine, started on day 1, or an inactive placebo.

Fourteen patients (40 percent) in the placebo group and two (5.7 percent) in the mirtazapine group developed depression, the team reports.

All 14 untreated patients who developed depression were then given mirtazapine, and all responded. For the two patients in the treatment group who developed depression, the dose of the antidepressant was increased and one responded

“Post-stroke depression should be considered and taken seriously in acute stroke care units, since prophylactic antidepressant treatment may be highly beneficial,” the investigators conclude.

SOURCE: Journal of Clinical Psychiatry, December 2004.