Stephen J.LurieMD, PhD, Contributing EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor
To the Editor: I read with interest the Clinical
Crossroads article1 on poststroke depression.
I was surprised, however, that this patient, who had 2 prior strokes and an
elevated risk of recurrent stroke with attendant disability, was not receiving
antiplatelet medication as prophlylaxis. If aspirin is contraindicated because
of history of ulcer, clopidrogel or ticlopidine could have been prescribed.
Also, was the stroke deemed "thrombotic" because a workup (eg, carotid Doppler
study, echocardiogram, or Holter monitor) for an embolic source was unrevealing?
Finally, Dr Robinson recommends nortriptyline or citalopram but does not discuss
the efficacy of sertraline in poststroke depression. Are there data indicating
that this medication is inferior to those he recommends?
Barrett AM. Treatment of Poststroke Depression. JAMA. 2000;284(8):959. doi:10.1001/jama.284.8.956