Therapy of early poststroke depression with venlafaxine: safety, tolerability, and efficacy as determined in an open, uncontrolled clinical trial.

Abstract

To the Editor: The development of persistent depressive symptoms is a severe and frequent complication of ischemic or hemorrhagic stroke.1 The etiology of poststroke depression is not well understood. Only few placebo-controlled, double-blind studies have been carried out, all reporting various degrees of superiority of standard antidepressants over placebos.1 2 On the other hand, serious side effects have been reported.3 4 In most of these studies, patients were examined whose stroke had occurred several weeks to several months before the antidepressive therapy was started. Antidepressive therapy in the first weeks after stroke has not yet been attempted in studies. Drug-induced improvement of neurotransmission, in particular adrenergic transmission, facilitates recovery in animal brain trauma and stroke models.5 Antidepressants enhance neurotransmission by blockade of serotonergic and/or adrenergic reuptake transporters, by blocking the enzymatic degradation of monoamines or by other mechanisms, such as the blockade of presynaptic adrenergic receptors. Therefore, the treatment with antidepressants might in some cases exert a favorable effect on functional recovery independent of the psychopathological state.6 We report data on the safety, tolerability, and efficacy of venlafaxine in patients suffering from acute poststroke depression. Venlafaxine was chosen because of its relatively good tolerability compared …