Depressive Symptoms in Stroke Patients: Are There Sex Differences?

Eun Jae Lee, Jong S. Kim, Dae Il Chang, Jong Ho Park, Seong Hwan Ahn, Jae Kwan Cha, Ji Hoe Heo, Sung Il Sohn, Byung Chul Lee, Dong Eog Kim, Hahn Young Kim, Seongheon Kim, Do Young Kwon, Jei Kim, Woo Keun Seo, Jun Lee, Sang Won Park, Seong Ho Koh, Jin Young Kim, Smi Choi-Kwon

    Research output: Contribution to journalArticlepeer-review

    4 Citations (Scopus)


    Background: We aimed to examine sex differences in symptom characteristics and pharmacological responses in post-stroke depressive (PSD) symptoms. Methods: This is a post hoc analysis of EMOTION (, NCT01278498), a randomized, placebo-controlled, double-blind trial that examined the efficacy of escitalopram for 3 months on depression in patients with acute stroke. Depressive symptoms were evaluated using the 10-item Montgomery-Åsberg Depression Rating Scale (MADRS). Baseline characteristics, clinical variables, and treatment responses to escitalopram were compared between male and female patients. Treatment responses were defined as changes in MADRS (total score and its components) between baseline and 3 months and were compared between the escitalopram and placebo groups within each sex group. The least square mean was calculated to determine the independent effect of escitalopram, of which interaction was evaluated with patient sex. Results: Of the 478 patients (intention-to-treat population), 187 (39%) were female. Female patients were significantly older than male patients and demonstrated more severe depressive symptoms at baseline (male vs. female, MADRS score, mean [SD]: 9.7 ± 8.0 vs. 12.2 ± 8.4, p = 0.001), especially in apparent sadness, reported sadness, and reduced appetite items. These differences were significant after adjustment for age and the severity of neurologic deficits. The female escitalopram group showed a significant 3-month improvement in MADRS scores (placebo [n = 86] vs. escitalopram [n = 101], least square mean [95% CI] -2.7 [-4.1 to -1.2] vs. -5.0 [-6.4 to -3.6], p = 0.007), and this efficacy was prominent in apparent sadness, reported sadness, and pessimistic thoughts items. However, there was no significant effect of escitalopram on depressive symptoms in the male group. The treatment responses of escitalopram tended to be more pronounced in the female group, particularly in alleviating a subset of depressive symptoms such as apparent sadness (p for interaction = 0.009). Conclusion: PSD may differ according to sex in its symptom characteristics and treatment responses to escitalopram, and tailored treatment strategies for PSD may therefore be needed.

    Original languageEnglish
    Pages (from-to)19-25
    Number of pages7
    JournalCerebrovascular Diseases
    Issue number1
    Publication statusPublished - 2020 Mar 1

    Bibliographical note

    Funding Information:
    Dong-A Pharmaceutical, the Ministry for Health and Welfare, Korea (HI14C1985, HI18C2383), and the Ministry of Science and ICT (NRF-2018M3A9E8066249)

    Publisher Copyright:
    © 2020 S. Karger AG, Basel. All rights reserved.


    • Depression
    • Sex
    • Stroke

    ASJC Scopus subject areas

    • Neurology
    • Clinical Neurology
    • Cardiology and Cardiovascular Medicine


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