***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The impact of clinical ly diagnosed depression on recovery in activities of daily living over a 2-year follow-up was examined in a prospect i ve study of 63 stroke patients . Although impairment in activities of daily living , neurologic diagnoses and findings , lesion location and volume as measured on computed tomographic scan , demographic variables , cognitive impairment , and social functioning were comparable between depressed ( n = 25 ) and nondepressed ( n = 38 ) patients during their acute hospitalization , the two groups had different patterns of recovery in activities of daily living . At 2 years after suffering a stroke , patients with an in-hospital diagnosis of depression ( either major or minor depression ) were significantly more impaired in both physical activities and language functioning than were non-depressed patients . Among patients with major depression , this disparity in the recovery profile was present even after the depression had remitted . This study emphasizes the need for early recognition and treatment of poststroke depression The efficacy of nortriptyline in the treatment of post-stroke depression was assessed by a double-blind study in thirty-four patients . Half of the patients had major depression .  There was a significantly greater improvement in depression in patients treated with  nortriptyline  than in a similar group of placebo-treated patients . Depression was measured by the Hamilton depression scale , Zung depression scale , present state examination , and an overall depression scale . Successfully treated patients had serum nortriptyline levels in the therapeutic range . Post-stroke depressions are common , severe , and longst and ing , and the demonstrated efficacy of nortriptyline provides an important addition to the treatments available for stroke patients The authors sought to determine the relative efficacy and tolerability of duloxetine versus citalopram and sertraline in the treatment of poststroke depression ( PSD ) , anxiety , and fatigue .  A group of 60 patients with PSD were assigned to receive duloxetine , citalopram , or sertraline and were assessed over a 3-month period for depression , anxiety , and fatigue . Improvement of depression and anxiety , but not fatigue , was observed in all study groups . Duloxetine was well tolerated and significantly more effective than citalopram and sertraline for the treatment of anxiety symptoms in PSD patients . None of the antidepressants used was effective for reducing symptoms of fatigue BACKGROUND AND PURPOSE Patients with poststroke major depression have a greater severity of cognitive impairment than nondepressed patients even when matched for size and location of stroke lesion . Prior treatment studies have consistently failed to show an improvement in cognitive function even when poststroke mood disorders responded to antidepressant therapy . We examined the response of cognitive function to treatment with nortriptyline or placebo in a double-blind trial . METHODS Patients with major ( n=33 ) or minor ( n=14 ) depression participated in a double-blind treatment study with nortriptyline or placebo . They were examined for change in depressive mood , measured by the Hamilton Rating Scale for Depression ( HAM-D ) , and change in cognitive impairment , assessed by the Mini-Mental State Examination ( MMSE ) , after treatment with nortriptyline or placebo .  Cognitive treatment response , as measured by the MMSE , was compared between patients whose depression did and did not respond to treatment . RESULTS Patients whose poststroke depression remitted ( predominantly associated with nortriptyline treatment ) had significantly greater recovery in cognitive function over the course of the treatment study than patients whose mood disorder did not remit ( predominantly associated with placebo treatment ) . CONCLUSIONS Our findings support the contention that poststroke major depression leads to a " dementia of depression . " Prior studies failed to show an effect of treatment because the effect size was too small . Successful treatment of depression may constitute one of the major methods of promoting cognitive recovery in victims of stroke BACKGROUND AND PURPOSE Early poststroke depression ( PSD ) is a frequent and specific entity that impairs the rehabilitation and functional recovery of hemiplegic patients . This trial was design ed to study the efficacy and tolerance of fluoxetine ( FLX ) in the treatment of early PSD . METHODS This was a multicenter , double-blind , placebo-controlled study . Recent hemiplegic patients ( <3 months ) suffering from major depressive disorder ( determined by International Classification of Diseases , 10th Revision , and Montgomery-Asberg Depression Rating Scale [ MADRS ] > 19 ) were r and omized to receive either 20 mg/d fluoxetine ( FLX ) or placebo for 6 weeks . Patients were evaluated by use of the Motricity Index , Mini-Mental State Examination , Functional Independence Measure , and MADRS . Statistical analysis was performed by using an intent-to-treat approach comparing the 2 groups at day 0 ( baseline ) and days 15 , 30 , and 45 ( end point ) . RESULTS Of 121 patients screened , 31 were included in the study , 16 in the FLX group and 15 in the placebo group . There were no significant differences in baseline characteristics among the 2 groups . The FLX-treated patients compared with placebo-treated patients demonstrated significant improvement in mean MADRS scores at end point ( 11.8+/-6 . 7 [ mean+/-SD ] versus 18.7+/-10.0 , respectively ; P=0.05 ) . FLX-treated patients compared with placebo-treated patients also demonstrated greater response rate ( 62.5 % versus 33.3 % , respectively ) and greater mean decrease of MADRS ( 16.6 versus 8.4 , respectively ; P=0.02 ) . There were no differences in motor , cognitive , or functional improvement and no significant side effects after FLX treatment , except for a patient with a moderate and transient increase of transaminases . CONCLUSIONS FLX is an efficacious and well-tolerated treatment for early PSD . Further research is needed to evaluate the efficacy and safety of long-term treatment in this population OBJECTIVE This study compared nortriptyline and fluoxetine with placebo in the treatment of depression and in recovery from physical and cognitive impairments after stroke . METHOD A total of 104 patients with acute stroke enrolled between 1991 and 1997 entered a double-blind r and omized study comparing nortriptyline , fluoxetine , and placebo over 12 weeks of treatment . The majority of patients were recruited from a rehabilitation hospital in Des Moines , Iowa , but other enrollment sites were also used . Both depressed and nondepressed patients were enrolled to determine whether improved recovery could be mediated by mechanisms unrelated to depression . Nortriptyline in doses of 25 mg/day gradually increased to 100 mg/day or fluoxetine in doses of 10 mg/day gradually increased to 40 mg/day or identical placebo were given over 12 weeks . Response to treatment of depression for individual patients was defined as a greater-than-50 % reduction in scores on the Hamilton Rating Scale for Depression and no longer fulfilling diagnostic criteria for major or minor depression . Improved recovery for a treatment group was defined as a significantly higher mean score from baseline to end of the treatment trial , compared with patients treated with placebo , on measures of impairment in activities of daily living and levels of cognitive and social functioning . RESULTS Nortriptyline produced a significantly higher response rate than fluoxetine or placebo in treating poststroke depression , in improving anxiety symptoms , and in improving recovery of activities of daily living as measured by the Functional Independence Measure . There was no effect of nortriptyline or fluoxetine on recovery of cognitive or social functioning among depressed or nondepressed patients . Fluoxetine in increasing doses of 10 - 40 mg/day led to an average weight loss of 15 . 1 pounds ( 8 % of initial body weight ) over 12 weeks of treatment that was not seen with nortriptyline or placebo . CONCLUSIONS Given the doses of medication used in this study , nortriptyline was superior to fluoxetine in the treatment of poststroke depression . Demonstrating a benefit of antidepressant treatment in recovery from stroke may require the identification of specific subgroups of patients , alternative measurement scales , or the optimal time of treatment OBJECTIVE Poststroke depression is a frequent psychiatric complication after stroke that may have strong negative impact on rehabilitation therapy and functional recovery . This study was conducted to show the efficacy and safety of early treatment with the selective serotonin reuptake inhibitor fluoxetine in post-stroke depressed patients . METHODS This double-blind , r and omized placebo-controlled study was of patients within two weeks after stroke . Moderate to severe depressed patients ( determined by Hamilton Depression Scale ( HDS ) > 15 , the Beck Depression Inventory ( BDI ) and the Clinical Global Impression ( CGI ) Scale ) were r and omized to receive either 20 mg/d fluoxetine or placebo for 3 months . Beside the psychiatric assessment , patients were evaluated by use of the Sc and inavian Stroke Scale ( SSS ) , the Mini-Mental-State-Examination ( MMSE ) and the Barthel-Index ( BI ) . An open-label long-term follow up was done 18 months after the initial assessment . RESULTS 54 depressed patients of an inpatient population of 242 consecutive stroke patients aged 25 to 85 years entered the trial within the first two weeks post-stroke . 50 patients completed the trial per- protocol . The initial severity of depression was comparable in the two groups ( mean baseline HDS score 32.8 in the fluoxetine vs. 30.3 in the placebo group ) , as were neurological symptom severity and demographic parameters . Significant improvement was seen in both groups within 4 weeks of treatment , whereas no advantages of fluoxetine could be observed at this time . This indicates a high degree of spontaneous recovery during early rehabilitation therapy . BDI scores of patients treated with fluoxetine further decreased until the follow-up at 12 weeks , whereas the scores increased again in the placebo group . This depressive relapse of the placebo patients after the end of most rehabilitation efforts was evident at a long-term follow-up 18 months after inclusion , when patients who had been treated with fluoxetine were significantly less depressed . No side effects of fluoxetine treatment were detected . CONCLUSIONS The advantages of fluoxetine were obvious at the follow-up 18 months after inclusion , but could not be demonstrated within the first three months of controlled treatment . The multitude of therapeutic efforts that take place in the early phase of rehabilitation might have facilitated spontaneous recovery from depression and might have hindered benefits of antidepressant treatment to become obvious . Fluoxetine treatment was well tolerated and safe Background and Purpose The aim of the study was to investigate the efficacy and safety of the selective serotonin reuptake inhibitor citalopram in treating poststroke depression , since available treatments are usually poorly tolerated . Methods A 6-week double-blind , placebo-controlled trial was undertaken . Diagnosis and outcome were determined using the Hamilton Depression Scale , and unwanted effects were measured using the UKU side effect rating scale .  Sixtysix consecutive depressed patients from an unselected population of 285 stroke patients aged 25 to 80 years entered the trial 2 to 52 weeks after stroke . They were assigned to equally sized treatment and placebo groups . The initial level of depression was comparable in the two groups ( mean baseline Hamilton Depression scores , 19.4 and 18.9 , respectively ) . Demographic parameters were also comparable in the two groups . Results Significantly greater improvement was seen in patients treated with citalopram ( 10 to 40 mg/d ) for 3 and 6 weeks , both when including all patients ( intention-to-treat analysis , p<.05 ) and excluding patients who dropped out during the first 3 weeks ( efficacy analysis , P<.005 ) . Half of the 28 patients who entered the trial 2 to 6 weeks after stroke recovered within 1 month , independent of the treatment given . This indicates a high degree of spontaneous recovery in the early phase after stroke . In contrast , recovery was infrequent in placebo group patients who became depressed 7 weeks or more after stroke . No serious side effects related to the treatment were detected ; those present were mild and usually transient . Conclusions This trial demonstrates that the selective serotonin reuptake inhibitor citalopram offers an advantageous new treatment of poststroke depression that is both safe and effective The incidence of depression following a hemispheric stroke ranges from 25 to 60 % . The benefit of antidepressant therapy on the outcome of rehabilitation in the subacute post-stroke phase is well known . We studied subjects both with and without evidence of depression , as indicated by any one of three criteria : ( i ) Clinical diagnosis of depression , ( ii ) Abnormal Zung-depression score . ( iii ) Abnormal dexamethasone suppression test ( DST ) . Patients in a stroke rehabilitation program ( 22 ) were r and omized to receive either placebo or 300 mg/day trazodone-HCl , beginning 30 days after the stroke . Patients with either a clinical diagnosis of depression or abnormal  Zung depression scores showed a consistent trend towards greater improvement in Barthel activities of daily living ( ADL ) scores , with antidepressant therapy , as compared to patients receiving placebo . An abnormal DST was associated with significant improvement in the ADL scores in subjects receiving trazodone , i.e. , in post-stroke depression such a treatment seems to be beneficial BACKGROUND Poststroke depression is a frequent condition and important to treat . The aim of this trial was to study the efficacy and tolerability of sertraline . METHOD In 4 Swedish stroke centers , 123 patients ( aged 70.7 + /- 9.9 years ) were enrolled during the period September 1998 to January 2001 in a r and omized , double- 
    Output:
    
All drugs were significantly more effective than placebo apart from sertraline , nefiracetam and fluoxetine .
After weighing the efficacy and acceptability , we conclude that paroxetine might be the best choice when starting acute treatment for PSD , and fluoxetine might be the worst choice .