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August 23/30, 2000

Treatment of Poststroke Depression

Author Affiliations

Stephen J.LurieMD, PhD, Contributing EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(8):959. doi:10.1001/jama.284.8.956

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?

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