. 2021 Nov 19;17:3359–3377. doi: 10.2147/NDT.S337865

Table 4.

Effects of Multimodal Strategies to Prevent PSD

Studies of Multimodal Strategies for Prevention of PSD
Reference	Country	Study Design	No. of Patients Recruited	Depressive Scale Exclusion	Recruitment After Stroke	Study Approach/Primary Endpoint/Follow-Up	Outcome of PSD/Assessment Depression Scale and Symptom Tool
Robinson⁵⁴	USA	RCT	176	Depressed by DSM-IV diagnosis	≤3 mo	1) Double-blinded placebo control escitalopram (<65 y: 10 mg/d; ≥65 y: 5 mg/d) for 12 mo	PSD in 8.5% escitalopram vs 22.4% placebo (P<0.001)/DSM-IV, HAM-D₁₇ >12
				Depressed by DSM-IV diagnosis			PSD in 11.9% PST vs 22.4% placebo (P<0.001)/DSM-IV, HAM-D₁₇ >12
				HAM-D₁₇ >11		2) Placebo
				HAM-D₁₇ >11		3) Non-blinded problem-solving therapy (PST) (6 treatment sessions over first 12 wks and 6 reinforcements at mo 4, 5, 6, 8, 10, 12)/12 mo/3, 6, 9, 12 mo
Hoffmann⁵⁵	Australia	RCT	33	None	Before discharge from hospital	1) Coping skills	No difference: coping skills vs usual care (P=0.177)/HADS
						2) Self-management
						3) Usual care. Each intervention included 8 face-to-face 1 h sessions/2 mo/2, 5 mo
							No difference: self-management vs usual care (P=0.565)/HADS
Mikami⁵⁶	USA	RCT	108	None	≤3 mo	1) Escitalopram (≥65 y: 10 mg/d; >65 y: 5 mg/d)	No difference: escitalopram vs PST vs usual care at 12 mo (P=0.3010)/HAM-D
						2) Problem-solving therapy (PST), 12 sessions
						3) Placebo/12 mo/12 mo
Hill⁵⁷	UK	RCT	450	None	≤1 mo	1) Problem-solving therapy (PST), 6 sessions over 3 mo	No difference: PST vs volunteer talking support vs usual care/caseness (PSE ≥5, GHQ-28 ≥9, major depression)
						2) Volunteer talking support, 6–8 sessions
						3) Usual care/12 mo/6, 12 mo
Narushima⁵⁸	USA	RCT	48	Major or minor depression	≤6 mo	1) Nortriptyline: 25 mg/d at wk 1, 50 mg/d at wks 2–3, 75 mg/d at wks 3–6, 100 mg/d at wks 7–12	PSD in 7.7% nortriptyline vs 20.0% fluoxetine vs 33.3% placebo at 3 mo (P=0.036)/DSM-IV, HAM-D
							PSD rate was higher for nortriptyline and fluoxetine vs placebo at 6 mo (P=0.047)/DSM-IV, HAM-D
						2) Fluoxetine: 10 mg/d at wks 1–3, 20 mg/d at wks 4–6, 30 mg/d at wks 7–9, 40 mg/d at wks 10–12
						3) Placebo group/12 wks/3, 6, 9, 12, 24 mo	No difference: nortriptyline vs fluoxetine vs placebo at 12 and 24 mo/DSM-IV, HAM-D

Abbreviations: HADS, Hospital Anxiety and Depression Scale; DSM, Diagnostic and Statistical Manual of Mental Disorders; HAM-D, Hamilton Depression Scale; PSE, Present State Examination: short form; GHQ-28, General Health Questionnaire; RCT, randomized controlled trial.