Post-Stroke Depressive Symptoms: Varying Responses to Escitalopram by Individual Symptoms and Lesion Location

Eun Jae Lee, Jong S. Kim, Dae Il Chang, Jong Ho Park, Seong Hwan Ahn, Jae Kwan Cha, Ji Hoe Heo, Sung Il Sohn, Byung Chul Lee, Dong Eog Kim, Hahn Young Kim, Seongheon Kim, Do Young Kwon, Jei Kim, Woo Keun Seo, Jun Lee, Sang Won Park, Seong Ho Koh, Jin Young Kim, Smi Choi-KwonMin Sun Kim, Ji Sung Lee

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3 Citations (Scopus)


Objective: The efficacy of antidepressants in post-stroke depressive symptoms (PSD) varies. We aimed to examine whether the effect of escitalopram on PSD differs according to individual depressive symptoms and stroke lesion location. Methods: This is a post hoc analysis of EMOTION (, NCT01278498), a randomized, placebo-controlled, double-blind trial that examined the efficacy of escitalopram on depression in acute stroke patients (237 with placebo, 241 with escitalopram). Depressive symptoms were evaluated with the 10-item Montgomery-Åsberg Depression Rating Scale (MADRS). Changes in MADRS and individual item scores at 12 weeks were compared between the treatment groups and among the stroke lesion location groups. Stroke lesion locations were grouped according to the anatomical distribution of serotonin fibers that originate from the midbrain/pons and spread to the forebrain via subcortical structures: “Midbrain-Pons,” “Frontal-Subcortical,” and “Others.” Least-squares means were calculated to demonstrate the independent effect of lesion location. Results: Total MADRS scores decreased more significantly in the escitalopram than in the placebo group, while a significant effect of escitalopram was observed in only 3 items: apparent sadness, reported sadness, pessimistic thoughts. In the lesion location analyses, escitalopram users in the Frontal-Subcortical group showed significant improvement in total MADRS scores (placebo [n = 130] vs. escitalopram [n = 148], least-square mean [95% CI]: -2.3 [-3.5 to -0.2] vs. -4.5 [-5.5 to -3.4], p =.005), while those in the Midbrain-Pons and Others groups did not. Conclusions: The effect of escitalopram on PSD may be more prominent in patients with particular depressive symptoms and stroke lesion locations, suggesting the need for tailored treatment strategies.

Original languageEnglish
Pages (from-to)565-573
Number of pages9
JournalJournal of Geriatric Psychiatry and Neurology
Issue number6
Publication statusPublished - 2021 Nov

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Jong S. Kim received grants from Dong-A Pharmaceutical, the Ministry for Health and Welfare, Korea (HI14C1985, HI18C2383), and Eun-Jae Lee received grants from the Ministry of Science and ICT (NRF-2018M3A9E8066249).

Publisher Copyright:
© The Author(s) 2020.

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Geriatrics and Gerontology
  • Psychiatry and Mental health


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