Efficacy and safety of agomelatine versus SSRIs/SNRIs for post-stroke depression: a systematic review and meta-analysis of randomized controlled trials

Oct 2, 2023International clinical psychopharmacology

Effectiveness and safety of agomelatine compared to common antidepressants for depression after stroke

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Abstract

A total of 857 patients with post-stroke depression were analyzed in this comparison of agomelatine and SSRIs/SNRIs.

After 6-12 weeks of treatment, the effectiveness of agomelatine and SSRIs/SNRIs was similar, as indicated by Hamilton Depression Rating Scale scores.
Agomelatine treatment was associated with higher scores on the Barthel Index, suggesting potential improvements in stroke recovery.
Participants receiving agomelatine experienced significantly fewer overall adverse reactions compared to those on SSRIs/SNRIs.
The incidence of neurological adverse reactions was also significantly lower in the agomelatine group.

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Agomelatine is effective in the treatment of depression, but its effect for post-stroke depression (PSD) remains unclear. This study was conducted to compare the efficacy and safety of agomelatine versus SSRIs/SNRIs in treating PSD. We systematically searched Embase, PubMed, Cochrane Library, WanFang Data, China National Knowledge Infrastructure, and Cqvip databases for double-blind randomized controlled studies comparing the efficacy and safety of agomelatine versus SSRIs/SNRIs for PSD until December 2022. The primary efficacy endpoint was the Hamilton Depression Rating Scale (HAMD) score, and the primary safety endpoint was the incidence of overall adverse reactions. Nine studies comprising 857 patients with PSD were included. After 6-12 weeks of treatment, the HAMD score ( P = 0.16) and the overall response rates ( P = 0.20) in the agomelatine group were comparable to that in the SSRIs/SNRIs group. Participants treated with agomelatine achieved higher Barthel Index scores compared with the SSRIs/SNRIs group ( P = 0.02). There was a significantly lower incidence of overall adverse reactions ( P = 0.008) and neurological adverse reactions ( P < 0.0001) in the agomelatine group. The efficacy of agomelatine for treating PSD is probably comparable to that of SSRIs/SNRIs, and it may improve stroke outcomes with better safety.

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Efficacy and safety of agomelatine versus SSRIs/SNRIs for post-stroke depression: a systematic review and meta-analysis of randomized controlled trials

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