Abstract Background and aims Post-stroke depression (PSD) is a common complication that adversely affects rehabilitation and long-term quality of life in stroke survivors, yet optimal pharmacologic therapy remains uncertain. Escitalopram, a selective serotonin reuptake inhibitor, has been proposed as a beneficial option due to its effects on serotonergic pathways. This systematic review and meta-analysis evaluated the efficacy and safety of escitalopram compared with placebo for treating PSD. Methods Following PRISMA guidelines, PubMed, Scopus, Web of Science, and the Cochrane Library were searched for randomized controlled trials assessing escitalopram in PSD. Six RCTs involving 1,197 participants were included. Extracted data covered study characteristics, baseline patient information, and outcomes such as Hamilton Depression Rating Scale (HAMD) scores, National Institutes of Health Stroke Scale (NIHSS), Barthel Index, Montreal Cognitive Assessment (MoCA), and emotional incontinence. Results Escitalopram significantly improved HAMD scores in three RCTs (229 patients) compared with placebo (MD = –3.01; 95% CI: –4.82 to –1.19; p = 0.001), with high heterogeneity (I2 = 84%) resolved in sensitivity analysis. Four RCTs (777 patients) demonstrated better NIHSS outcomes with escitalopram (MD = –1.74; 95% CI: –2.82 to –0.12; p = 0.03; I2 = 97%). Three RCTs (574 patients) showed significant improvements in Barthel Index scores (MD = 13.17; 95% CI: 11.34 to 15.00; p 0.0001; I2 = 0%). No significant differences were observed for MoCA scores (MD = –0.80; p = 0.13; I2 = 0%) or emotional incontinence (OR = 0.60; p = 0.08; I2 = 27%). Conflict of interest all authors have has nothing to disclose Figure 1 - belongs to Methods Figure 2 - belongs to Results
Serag et al. (2026) studied this question.