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Do antidepressants improve recovery from neurologic illness?

M depression is far more common among patients in the first year following acute stroke than in the general population, with a prevalence estimated at 33% (95% CI [confidence interval]: 29%–36%).1 The recognition of depression following stroke is particularly important, since the presence of either major or minor depression has been associated with increased disability2,3 as well as approximately a threefold increase in 10-year mortality.4 In this edition of the journal, Mikami et al.5 report on a 1-year follow-up of measured disability of participants enrolled in a 12-week randomized controlled trial of fluoxetine, nortriptyline, and placebo following acute stroke. In their study, antidepressant doses were gradually titrated up over the acute phase of the trial: nortriptyline was increased from 25 mg a day in the first week to 100 mg a day by 6 weeks, and fluoxetine was titrated from 10 mg a day in the first week to 40 mg a day by 9 weeks. The authors demonstrated a significant reduction in disability over 1 year as rated by the modified Rankin scale among those treated with either fluoxetine or nortriptyline, compared with those treated with placebo. The differences were small, but statistically significant and meaningful. According to their descriptions of the Rankin scale, on average at baseline patients had some difficulty with ambulation and required some degree of assistance with bodily care. While the placebo group was largely unchanged over time, by 1 year the antidepressant group was largely