Cao 2020.

Study characteristics
Methods	RCT Study type: interventional (clinical trial) Primary purpose: prevention
Participants	100 participants January 2013 to April 2016 Country: China Setting: inpatient At randomisation number allocated: N = 99: escitalopram (n = 52); usual care (n = 47) % male: escitalopram (%); usual care (%) Inclusion criteria First ever acute anterior circulation cerebral infarction Met the American Heart Association/American Stroke Association diagnostic criteria for stroke Hospitalised within 1 week of stroke onset Stroke confirmed cranial MRI Exclusion criteria Recurrent stroke, haemorrhagic stroke and posterior circulation stroke Pre‐stroke depression, history of depression, or receiving mood stabilisers, antipsychotics, or any antidepressant before enrolment Depression caused by other organic brain diseases, or depression caused by psychoactive substances and non‐addictive substances Consciousness disorder, aphasia, and dementia HAMD of ≥ 17 NIHSS score of ≥ 20 History of cancer and psychosis Chronic obstructive pulmonary disease, heart failure, pulmonary, hepatic, or renal failure, or other severe chronic diseases Serious suicidal tendencies Laboratory and accessory examinations revealing coagulation dysfunction Patients who refuse to participate or cooperate
Interventions	Experimental: prophylactic escitalopram in addition to the basic therapies. Started with 5 mg and gradually titrated to 10 mg/d, oral administration in the morning for 90 days Comparator: usual care. Secondary prevention of cerebral infarction, brain protection therapy and rehabilitation, without any antidepressants. People with difficulty sleeping could receive Zolpidem or benzodiazepines for a short period of time
Outcomes	Primary and secondary outcome measures not stated 17‐item HAMD NIHSS MMSE BI
Funding source
Notes	No trial registration information Dates study conducted: All patients were hospitalised patients treated for acute ischaemic stroke from January 2013 to April 2016 Declarations of Interest: none reported
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Random number table
Allocation concealment (selection bias)	Unclear risk	Insufficient information available to permit a judgement of ‘low risk’ or ‘high risk’. This is usually the case if the method of concealment is not described or not described in sufficient detail to allow a definite judgement
Blinding of participants and personnel (performance bias) All outcomes	High risk	Control group did not receive a placebo
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Treatment evaluation conducted by a physician blind to patient’s clinical data, but it does not state whether the physician was blind to treatment allocation. So the judgement was that the risk of bias was unclear
Incomplete outcome data (attrition bias) All outcomes	High risk	There are two publications‐the numbers initially included in the two papers do not match; also two patients out of 49 randomised to escitalopram dropped out. Given the inconsistency in the numbers reported, we judge that there is the potential for high risk of bias
Selective reporting (reporting bias)	Unclear risk	No protocol is available
Other bias	Unclear risk	The authors did not reply to questions and so we have graded this as unclear