Critical Analysis: Antidepressant Effects on Post-Stroke Depression

This report presents a critical appraisal of the article "Treatment effects of antidepressants in patients with post-stroke depression: a meta-analysis" by Chen, Guo, Zhan, and Patel, published in the Annals of Pharmacotherapy in 2006. The study conducted a meta-analysis of randomized, placebo-controlled trials to assess the efficacy of antidepressants in treating post-stroke depression. The analysis included studies published between 1984 and 2006 and found a significant improvement in depressive symptoms with antidepressant use. The report critically evaluates the study's introduction, problem statement, objectives, literature review, methodology, variables, research design, sample, measurement strategies, data collection procedures, statistical techniques, and interpretation of findings. It also discusses the study's limitations, generalization of findings, implications for clinical practice, and replicability. The appraisal highlights the strengths and weaknesses of the study, including the strength of the research problem and limitations in the literature review, framework, and sampling methods. The report concludes by summarizing the study's contributions and suggesting areas for future research, emphasizing the professional and informative nature of the article in supporting the continued use of antidepressants among stroke patients suffering from depression.

Running head: CRITICAL ANALYSIS 1
Critical Appraissal: “Treatment effects of antidepressants in patients with post-stroke
depression: a meta-analysis”.
Student’s Name
Date of Submission

CRITICAL ANALYSIS 2
Critical Appraissal: “Treatment effects of antidepressants in patients with post-stroke
depression: a meta-analysis”.
This paper is a critical appraisal of the articles titled, ‘Treatment effects of
antidepressants in patients with post-stroke depression: a meta-analysis’. This article was written
by the authors Chen, Guo, Zhan and Patel in the year 2006 and published in the journal of
Annals of Pharmacotherapy, issue number 40, and volume 12. This research was important
because the authors affirm that depression is common in post stroke patients and hence the need
for its treatment. Since antidepressants are common methods of treatment of this depression, the
research sought to analyze its effects in clinical practice. It involved the analysis of data from a
meta-analysis of a randomized placebo-controlled trials of antidepressants in post stroke
depression patients from the use of articles published between 1984 to 2006. The critical
appraisal is quite significant because it enables the health experts to identify high quality
scientific literature that has been published in connection to their practice. Information derived
from such articles and critical analysis of such articles enables them to be updated with recent
advances in the treatment approach of common clinical and health conditions. The data obtained
was secondary in nature since it was sourced from research articles published between the years
1984 to 2006 concerning use of antidepressants in post stroke disorder patients. The results
obtained in this research as presented on the abstract is that out of the 1320 enrolled participants,
the RD was 0.23 at 95% confidence interval in the active group. Moreover, with increased
duration of post stroke depression treatment using antidepressants, there was a significant
improvement in the symptoms of depression at p=0.001. The authors conclude that when
antidepressants are used to treat post stroke disorder, an improvement in the symptoms are used.

CRITICAL ANALYSIS 3
Critical analysis
A. Introduction
Chen et al., (2006) gives a brief introduction of the post stroke disorder and how it is
associated with negative health effects. While the use of depressants has been used to improve
the depressive symptoms of this condition, the available data is scarce. Such symptoms of stroke
negatively impact the quality of life, rehabilitation outcomes and the overall recovery process.
The authors admit that in order to reduce the morbidity and mortality linked with post trauma
depression, it is important to seek proper treatment options (Starkstein et al., 2008).
B. Statement of the problem
The authors of this article admit the fact that depression is quite common in patients
suffering from stroke (Paolucci, 2017). Depressed stroke patients have their functional abilities
negatively affected and hence are not productive enough (Chen et al., 2006). Previous studies on
the use of antidepressants in post trauma depression randomized trials have been inconsistent due
to a number of factors such as low sample sizes, inadequate statistical work and varied outcome
measurements. The authors argue that there are two meta-analysis published in literature about
this topic but they are not informative enough. An example is the literature by Hackett et al.,
(2005) while another one was by Bhogal et al., (2005) which had only six studies with
consideration to patients of 45 years and above only.
C. Statement the purpose
The main aim of this study was to determine whether the antidepressants have a positive
effect on patients suffering from post-stroke depression, by conducting a meta-analysis.

CRITICAL ANALYSIS 4
D. Literature review
Chen et al., (2006) performed a meta-analysis of recent literature concerning the positive
impacts of the use of antidepressants in the treatment of stroke patients suffering from
depression. The authors first acknowledge that depression in stroke patients is quite common and
negatively affects the levels of their lives leading to morbidities and mortalities (Yan et al.,
2015). Although antidepressants are used to counter these effects, there does not exists recent
articles and meta-analysis regarding the use of antidepressants.
E. Study framework or theoretical perspective
There is no exact study framework provided by the authors and hence it is upon the
reviewers to come up with frameworks adopted in this research.
F. Research objectives, questions, or hypotheses
The objective of this article was to determine the positive effects of using antidepressants
in the treatment of post stroke depression, by use of data from recently published resources. The
research question was, ‘What are the benefits of using antidepressants on post stroke depression
patients? However, the nature of this study did not allow the stating of any hypothesis since it
was descriptive in nature (Chen et al., 2006).
G. Study variables or concepts
The variables used in this article were: depression, response rates, recovery of
neurological impairments, and activities of daily living improvements (dependent variables) as a
result of use of antidepressants independent variable).
H. Demographic variables and other relevant terms.
Chen et al., (2006) described a number of demographic variables present in the study
population and these are age, gender, and physical presentation among others.

CRITICAL ANALYSIS 5
I. Identify the research design.
This was a meta-analysis of recently published randomized control literature on the
effectiveness of antidepressants among depressed stroke patients.
J. Description of the sample and the setting
The inclusion criteria for this research was: any randomized control trials that compared
one antidepressant and a placebo, patients with computer or clinical diagnosed stroke, and
patients diagnosed with depression caused by stroke based on Diagnostic and statistical manual
of mental disorders (Chen et al., 2006). On the other hand, all the studies that had mixed group
of patients such as those with stroke but not suffering from depression were excluded from this
study.
K. Identify and describe each measurement strategy in the study.
The Jaded scale was used to assess the level of quality of the included studies on the basis
of double blinding, and randomization. In order to determine the effects of time on the
effectiveness of antidepressants, the HDRS (Chen et al., 2006).
L. Describe the procedures for data collection - the study protocol
In this meta-analysis, there was no exact study protocol that has given. However, it has
been indicated that data collection, sorting, entry and analysis was carried out. Therefore, when
data was obtained from the reviewers, any arising disagreements were sorted through group
discussions.
M. Describe the statistical techniques performed to analyze the study data.
Data was analyzed using the Revman 4.2.7 where the significance level was determined
at the alpha level of 0.05. The effects of treatment of depression on stroke patients by the use of
antidepressants were reported as weighted mean difference and rate difference.

CRITICAL ANALYSIS 6
N. Describe the researcher’s interpretation of findings.
The researchers from the findings of this research argue that use of antidepressants can
achieve significant effectiveness in the treatment of depression in patients suffering from stroke
(Sun et al., 2017). However, it is not clear the effects of activity daily life of the patients.
O. What study limitations did the researcher identify?
The limitations of this study is that as a result of the strictness in terms of inclusion and
exclusion criteria of the randomized control trials for this research, the patients that were pooled
could not be representative enough of the patients suffering from post-stroke depression in actual
sense (Paolucci, 2017). This in turn affected the ability to generalize the research findings to the
rest of the population.
P. How did the researcher generalize the findings?
Chen et al., (2006) generalized their findings that when post stroke depression is treated
effectively, recovery can be achieved quite well. Some anti-depressants like the serotonin-
reuptake inhibitors enhance neuronal recovery in the brain (Swartz et al., 2016).
Q. What were the implications of the findings for clinical practice?
In clinical practice, the use of antidepressants can achieve improvements in the post
stroke depression patients (Xu et al., 2016). Moreover, increased durations of use of
antidepressants is associated with better outcomes. However, it is not yet clear on the exact
duration of therapy that can achieve the highest effectiveness of suppressing depression in these
patients.

CRITICAL ANALYSIS 7
R. Is the description of the study sufficiently clear for replication?
Chen and colleagues (2006) have given readers a step-wise flow of the protocols used in
conducting this meta-analysis. Since the methods are quite clear including data analysis, then this
study can be replicated in order to compare the findings.
Strengths and weaknesses
Research problem: The research problem was strong enough because it captured the
actual problem that was being investigated.
Literature review: The review of literature was quite shallow because it did not indicate
examples of previous articles and their findings for comparison purposes.
Framework: There was no exact study framework provided in this article.
D. Research objectives, questions, or hypotheses- the objective was clearly stated but
the research question was inferred to. Owing to the nature of this study as being descriptive, no
hypothesis was stated.
E. Variables- both dependent and independent variables were stated but none was linked
to the research framework.
F. Design- the study design used was descriptive that involved analysis of previous
literature. The procedure was stepwise and can be easily replicated.
G. Sample, population, setting – the sampling method used by Chen and colleagues
(2006) was not quite representative for the population because the inclusion and exclusion
criteria were too strict. However, some initial study aims were excluded since the available data
was not sufficient enough: such as the duration of therapy that could achieve more effectiveness.

CRITICAL ANALYSIS 8
H. Measurements – methods used were sensitive, and adequate for this study.
I. Data collection- the use of data collection forms was not clearly described while the
selection of the two reviewers described, although the process of article selection is clearly
illustrated.
J. Data analysis- data analysis methods used were fine for this data and outputs were
presented in form of tables for ease of understanding. Thus the description of data analysis was
detailed enough to cover the objectives.
K. Interpretation of findings- the findings were interpreted correctly based on the
obtained results and extrapolated in for application in clinical settings use of antidepressants. The
findings were also compared to previous research in the same topic and variations and
similarities explained.
Evaluation of the study
The study carried out by Chen and colleagues (2006) was quite descriptive to enable
readers understand the effectiveness of antidepressants in treatment of depression in stroke
patients. While several questions were answered, the study had some limitations such as high
strictness for inclusion and exclusion criteria. However, the study has some gaps that can be
filled through further studies such as determination of the exact therapy durations where
maximal antidepressant activity can be achieved.
Summary
This study was done in a better manner as compared to previous studies on the same
topic. The study was stepwise and was able to cover a number of issues and factors relating to
stroke and depression (Xu et al., 2016). In my own opinion, this article gives a greater support on
the importance of continued use antidepressants among stroke patients suffering from

CRITICAL ANALYSIS 9
depression. Generally, this article is quite professional and informative, covering all the broad
aspects and the objectives of the research has been met. (Robinson & Jorge, 2015).

CRITICAL ANALYSIS 10
References
Bhogal SK, Teasell R, Foley N, Speechley M. (2005). Heterocyclics and selective serotonin
reuptake inhibitors in the treatment and prevention of poststroke depression. J Am Geriatr
Soc, 53:1051-7.
Chen, Y., Guo, J. J., Zhan, S., & Patel, N. C. (2006). Treatment effects of antidepressants in
patients with post-stroke depression: a meta-analysis. Annals of Pharmacotherapy,
40(12), 2115-2122.
Hackett ML, Anderson CS, House AO. (2005). Management of depression after stroke: a
systematic review of pharmacological therapies. Stroke;36: 1098-103.
Paolucci, S. (2017). Advances in antidepressants for treating post-stroke depression. Expert
opinion on pharmacotherapy, 18(10), 1011-1017.
Pohjasvaara, T., Vataja, R., Leppävuori, A., Kaste, M., & Erkinjuntti, T. (2001). Depression is an
independent predictor of poor long‐term functional outcome post‐stroke. European
Journal of Neurology, 8(4), 315-319.
Robinson, R. G., & Jorge, R. E. (2015). Post-stroke depression: a review. American Journal of
Psychiatry, 173(3), 221-231.
Starkstein, S. E., Mizrahi, R., & Power, B. D. (2008). Antidepressant therapy in post-stroke
depression. Expert opinion on pharmacotherapy, 9(8), 1291-1298.
Sun, Y., Liang, Y., Jiao, Y., Lin, J., Qu, H., Xu, J., & Zhao, C. (2017). Comparative efficacy and
acceptability of antidepressant treatment in patients with post-stroke depression: a
multiple-treatments meta-analysis. The Lancet, 390, S3.
Swartz, R. H., Bayley, M., Lanctôt, K. L., Murray, B. J., Cayley, M. L., Lien, K., ... & Casaubon,
L. K. (2016). Post-stroke depression, obstructive sleep apnea, and cognitive impairment:

CRITICAL ANALYSIS 11
rationale for, and barriers to, routine screening. International journal of stroke, 11(5),
509-518.
Xu, X. M., Zou, D. Z., Shen, L. Y., Liu, Y., Zhou, X. Y., Pu, J. C., ... & Wei, Y. D. (2016).
Efficacy and feasibility of antidepressant treatment in patients with post-stroke
depression. Medicine, 95(45).
Yan, D., Shan, J., Ze, Y., Xiao-yan, Z., & Xiao-hua, H. (2015). The effects of combined
hyperbaric oxygen therapy on patients with post-stroke depression. Journal of physical
therapy science, 27(5), 1295-1297.