Depressed Stroke Patients may find Help with Nortriptyline

Clinically important depression occurs in some 30-60% of post-stroke patients. In a double-blind trial the effects of nortriptyline on post-stroke depression were studied in 39 patients with thromboembolic stroke or intracerebral haemorrhage. 32 required treatment (single daily bedtime dose) for 6 weeks: 20 mg/day for 1 week, 50 mg/day for 2 weeks, 70 mg/day for 1 week, then 100 mg/day for 2 weeks. Seven patients entered a 4-week treatment period: 50 mg/day for 1 week, 70 mg/day for 2 weeks, then 100 mg/day for 1 week.

Five patients withdrew within the first week and were excluded from treatment assessment. Of the remaining 14 nortriptyline and 20 placebo patients, 11 and 15, respectively, completed the full treatment. Of all patients assessed, 50% of nortriptyline and 60% of placebo patients had major depression. When only those who completed the study were included, the respective figures were 45% and 53%. The Hamilton depression scale, Zung self-rating scale, present state examination, and overall depression score were used to assess depression. On each scale, the nortriptyline patients showed significantly greater improvement than the placebo group.

While the risk of complications, and various contraindications, must be considered (particularly in elderly patients) ' ... the success of nortriptyline in the treatment of post-stroke depression represents a potentially important advance in the treatment of stroke patients.' Lipsey, JR et al.: Lancet 1: 297 (1 1 Feb 1984)

0156-2703/ 84/ 0303-0011 / 0$01.00/0 © ADIS Press INPHARMA® 3 Mar 1984 11