A Meta-Analysis On Clinical Outcome And Safety Of Citalopram Versus Amitrptyline In Patients With Post-Stroke Depression

Objectives:Post-stroke depression which includes a lot of modes of treatment is a common occurrence after stroke, citalopram and amitriptyline are the preferable pharmacotherapy of PSD in clinical practice, and we intend to compare the clinical outcomes and safety of citalopram versus amitriptyline for PSD.MethodsTo search all the reports of randomized control trials of citalopram versus amitriptyline for post-stroke depression, the search range included Medline Database, EMBASE Database, Cochrane Library, WANFANG full-text Database, CNKI Database, the China Biological Medicine Database and etc. Two researchers independently completed the extraction of the details of clinical trials and evaluation of the quality of the studies, the quality of the studies were assessed by Jadad scale, Software Revman5.1 was employed to analysis the data and evaluate the publication bias. Results:According to search strategy, 19 clinical randomized control trials (1110 patients) were included in the meta-analysis. The effect rate of the patients with post-stroke depression was examined by heterogeneity test after the treatment of 6 weeks or 8 weeks by citalopram and amitriptyline respectively, there was no heterogeneities in the two medical groups, fixed effect model was applied, the 95%CI of the RR values of 6 weeks and 8 weeks were 1.10[1.02, 1.18] and 1.05[0.97, 1.14]. The HAMD scores at the end of 1 week and 2 weeks were examined by heterogeneity test after the treatment of citalopram and amitriptyline respectively, the randomized effect model was applied because the data were heterogeneous, the 95%CI of the MD values at the end of 1 week and 2 weeks were -4.08[-6.63,-1.54] and -3.76[-4.88,-2.63]. The HAMD scores at the end of 4 week, 6 weeks and 8 weeks was examined by heterogeneity test after the treatment of the two medicine respectively, the fixeded effect model was applied because there were no heterogeneities, the 95%CI of the MD values at the end of 4 weeks, 6 weeks and 8weeks were -1.98[-2.68,-1.29], -1.37[-1.79,-0.96] and -1.47[-2.69,-0.25]. The TESS scores at the end of 1 week, 2 weeks, 4weeks and 8 weeks were examined by heterogeneity test after the treatment of citalopram and amitriptyline respectively, the randomized effect model was applied because the data were heterogeneous, the 95%CI of the MD values at the end of 1 week, 2 weeks, 4weeks and 8 weeks were -3.85[-7.23,-0.47],6.09[-7.43,-4.76],-6.16[-7.59,-4.73] and -3.66[-5.32,-1.99]. The HAMD scores at the end of 6 weeks was examined by heterogeneity test after the treatment of the two medicine respectively, the fixed effect model was applied because there were no heterogeneities, the 95%CI of the MD values at the end of 6 weeks was -5.85[-6.42,-5.27].Conclusions:1. The effect rate of the patients with post-stroke depression treated by citalopram was higher than the patients treated by amitriptyline by the end of 6 weeks, there were no significant difference between the effect rate of patients treated by citalopram or amitriptyline by the end of 8 weeks.2. The degree of depression of the patients with post-stroke depression treated by citalopram at the end of 1 week, 2 weeks, 4 weeks, 6 weeks, 8 weeks was milder than the patients treated by amitriptyline.3. The degree of side effects of the patients with post-stroke depression treated by citalopram at the end of 1 week, 2 weeks, 4 weeks, 6 weeks, 8 weeks was less than the patients treated by amitriptyline.