***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: Background : Parkinson disease ( PD ) is a common neurodegenerative disease affecting up to 1 million individuals in the United States . Depression affects up to 50 % of these patients and is associated with a variety of poor outcomes for patients and their families . Despite this , there are few evidence -based data to guide clinical care . Methods : An NIH-funded , r and omized , controlled trial of paroxetine CR , nortriptyline , and placebo in 52 patients with PD and depression . The primary outcomes were the change in the Hamilton Depression Rating Scale ( HAM-D ) and the percentage of depression responders at 8 weeks . Results : Nortriptyline was superior to placebo for the change in HAM-D ( p < 0.002 ) ; paroxetine CR was not . There was a trend for superiority of nortriptyline over paroxetine CR at 8 weeks ( p < 0.079 ) . Response rates favored nortriptyline ( p = 0.024 ) : nortriptyline 53 % , paroxetine CR 11 % , placebo 24 % . In planned contrasts of response rates , nortriptyline was superior to paroxetine CR ( p = 0.034 ) . Nortriptyline was also superior to placebo in many of the secondary outcomes , including sleep , anxiety , and social functioning , while paroxetine CR was not . Both active drug treatments were well tolerated . Conclusions : Though relatively modest in size , this is the largest placebo-controlled trial done to date in patients with Parkinson disease ( PD ) and depression .  Nortriptyline was efficacious in the treatment of depression and paroxetine CR was not . When compared directly , nortriptyline produced significantly more responders than did paroxetine CR . The trial suggests that depression in patients with PD is responsive to treatment and raises questions about the relative efficacy of dual reuptake inhibitors and selective serotonin reuptake inhibitors . ARR = absolute risk reduction ; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders , 4th edition ; HAM-A = Hamilton Anxiety Scale ; HAM-D = Hamilton Depression Rating Scale ; MMSE = Mini-Mental State Examination ; NNT = number needed to treat ; PD = Parkinson disease ; PDQ = Parkinson ’s Disease Question naire ; PSQI = Pittsburgh Sleep Quality Index ; SCID = Structured Clinical Interview ; SSRI = selective serotonin reuptake inhibitor ; TCA = tricyclic antidepressant ; UPDRS = Unified Parkinson ’s Disease Rating Scale 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 Forty-two patients with depression and epilepsy were entered into an antidepressant trial of amitriptyline , nomifensine and placebo . The dose of the active drug was 25 mg tid , which was doubled in non-responders on the active drug after 6 weeks . At that point a further 6 week follow-up was carried out . Serum antidepressant and anticonvulsant levels were assessed . The results indicated that at 6 weeks all patients showed a decline in their depression scores but at 12 weeks nomifensine was superior to amitriptyline . The possible reasons for this and the clinical implication s of this are discussed 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 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 In a double-blind clinical trial involving 28 patients with multiple sclerosis and major depressive disorder , 14 patients were r and omly assigned to a 5-week trial of desipramine and individual psychotherapy and 14 to placebo plus psychotherapy .  Clinical judgments indicated that patients treated with desipramine improved significantly more than the placebo group . This was confirmed by scores on the Hamilton Rating Scale for Depression but not by Beck Depression Inventory scores . Side effects limited desipramine dosage in half of the treated patients . The authors conclude that desipramine has a modest beneficial effect in serious depression associated with multiple sclerosis but that side effects may be more of a limiting factor than in patients without medical or neurologic disease 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-blind , placebo-controlled 26-week trial , at a mean of 128 + /- 97 days ( range , 3 - 375 days ) after stroke , if they fulfilled DSM-IV criteria of major depressive episode ( N = 76 ) or minor depressive disorder ( N = 47 ) . The primary efficacy variable was a change in depression assessed by the Montgomery-Asberg Depression Rating Scale . The Emotional Distress Scale ( EDS ) was administered and the occurrence of emotionalism and quality of life ( QoL ) were assessed , as well as neurologic recovery . Efficacy analyses were intention-to-treat , short-term ( week 6 ) and long-term ( week 26 ) . RESULTS Of the 123 patients , 62 were treated with sertraline ( 50 - 100 mg/day ) and 61 with placebo . Both groups improved substantially , with no differences between the treatments , either for major depressive episode or minor depressive disorder , or for short- or long-term antidepressant effect and neurologic outcome . EDS revealed a better outcome with sertraline at week 6 ( p < .05 ) . At week 26 , the improvement in QoL was better in sertraline patients ( p < .05 ) and there was a trend for emotionalism ( p = .07 ) . No serious side effects were seen . CONCLUSION Poststroke depression as measured by a conventional depression rating scale improved over time irrespective of treatment . Positive effects specific to sertraline were identified in emotional distress , emotionalism , and QoL. The study indicates that poststroke emotional reactions comprise de 
    Output:
    
The evidence favoured the use of antidepressants over placebo at all time points although pooled results were not statistically significant at all time points .
Fewer data were available for quality of life , and functional and cognitive outcomes , and there was little evidence of improvement with antidepressant treatment .
INTERPRETATION Antidepressants are effective for the treatment of depression in patients with neurological disorders but the evidence for the efficacy of antidepressants in improving quality of life , and functional and cognitive outcomes is inconclusive