ABSTRACT NUMBER: ESOC2026A441 SAFETY AND EFFECTIVENESS OF ESCITALOPRAM VERSUS PLACEBO IN THE TREATMENT OF POST-STROKE DEPRESSION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Abstract Background and aims Post-stroke depression (PSD) is a common neuropsychiatric complication that adversely affects functional recovery, cognitive performance, and quality of life in stroke survivors. Despite its high prevalence, optimal pharmacological management remains uncertain. Escitalopram, a selective serotonin reuptake inhibitor, may improve depressive symptoms and neurological recovery by enhancing serotonergic neurotransmission. Aim To systematically evaluate the effectiveness and safety of escitalopram compared with placebo in the treatment of post-stroke depression. Methods This systematic review and meta-analysis followed 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 patients were included. Outcomes assessed included Hamilton Depression Rating Scale (HAMD), National Institutes of Health Stroke Scale (NIHSS), Barthel Index, Montreal Cognitive Assessment (MoCA), and emotional incontinence. Risk of bias was evaluated using the Cochrane ROB2 tool. Meta-analyses were performed using RevMan 5.3. Results Escitalopram significantly improved depressive symptoms compared with placebo, as demonstrated by reduced HAMD scores (MD −3.01; 95% CI −4.82 to −1.19; p=0.001). Neurological outcomes favored escitalopram, with significant improvement in NIHSS scores (MD −1.74; 95% CI −2.82 to −0.12; p=0.03). Functional independence was also enhanced, with higher Barthel Index scores (MD 13.17; 95% CI 11.34–15.00; p<0.0001). No significant differences were observed in MoCA scores or emotional incontinence between groups. Conclusions Escitalopram is an effective and generally safe treatment for post-stroke depression, offering significant benefits in depressive symptoms and functional recovery. Further large-scale trials are warranted to confirm these findings and clarify long-term outcomes. Conflict of interest all authors have has nothing to disclose Figure 1 - belongs to Methods Figure 2 - belongs to Results Figure 3 - belongs to Conclusions