Summary of findings 1. Pharmacological interventions (antidepressants) compared to placebo for preventing depression after stroke.
| Pharmacological interventions (antidepressants) compared to placebo for preventing depression after stroke | ||||||
| Patient or population: people with stroke Setting: hospital and community Intervention: pharmacological interventions (antidepressants) Comparison: placebo | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with placebo | Risk with pharmacological interventions (antidepressants) | |||||
| Depression: meeting study criteria for depression at end treatment (Analysis 1.1) | Study population | RR 0.50 (0.37 to 0.68) | 734 (9 RCTs) | ⊕⊝⊝⊝ Very lowa,b | ||
| 250 per 1000 | 125 per 1000 (92.5 to 170) | |||||
| Scoring above cut‐off points for a depressive disorder at end of treatment (Analysis 1.2) | ‐ | ‐ | (0 RCTs) | ‐ | No data available. | |
| Depression: mean scores at end of treatment (Analysis 1.4) | MD 0.59 higher (1.46 lower to 2.63 higher) | ‐ | 100 (4 RCTs) | ⊕⊝⊝⊝ Very lowa,c | HDRS (high score = more depressed) | |
| Cognition: mean scores at end of treatment (Analysis 1.6) | MD 0.42 lower (2.60 lower to 1.76 higher) | ‐ | 48 (2 RCTs) | ⊕⊝⊝⊝ Very lowa,c | MMSE (low score = cognitive impairment) | |
| Activities of daily living: mean scores at end of treatment (Analysis 1.8) | MD 3.86 lower (9.48 lower to 1.77 higher) | ‐ | 116 (3 RCTs) | ⊕⊝⊝⊝ Very lowa,c | Barthel Index (high score = more dependent) | |
| Disability: mean scores at end of treatment (Analysis 1.10) | ‐ | ‐ | 204 (4 studies) | ‐ | No totals. Hemispheric Stroke Scale Total Score (high score = more neurological deficit) Johns Hopkins Functioning Inventory (high score = less function) |
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| Adverse events: death ‐ at end of treatment Analysis 1.12 | Study population | RR 1.25 (0.32 to 4.91) | 496 (9 RCTs) | ⊕⊝⊝⊝ Very lowa,c | ||
| 0 per 1000 | 0 per 1000 (0 to 0) | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; HDRS: Hamilton Depression Rating Scale; MMSE: Mini Mental State Examination; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | ||||||
aWe downgraded the certainty of evidence as the studies were rated as unclear or high risk in multiple risk of bias domains.
bWe downgraded the certainty of evidence because the confidence intervals were wide.
cWe downgraded the certainty of evidence because the confidence intervals were very wide.