The Preventive Effect of Escitalopram on Depression and Related Emotional Disorders in Acute Stroke Patients (EMOTION)

Inclusion Criteria:

• Adults older than 20 years
• Patients with acute stroke (ischemic stroke or cerebral hemorrhage) confirmed by neuroimaging within 21 days after stroke onset
• Patients with hemorrhagic transformation of infarcted tissue will not be included, but if investigators judge the risk of bleeding is small (i.e., reduced amount of blood in follow-up neuroimaging) those patients can be enrolled.
• Patients with MRS ≥ 2 on screening
• Patients without definite history of depression
• Patients who fulfill the following criteria in the K-MADRS test:

The combined score of the 9th question (pessimistic thoughts) and the 10th question (suicidal idea) ≤ 7 The score of the 10th question < 6

• Patients without serious communication problem
• Patients who agree to participate in this trial

Exclusion Criteria:

• Patients with MRS 0 or 1 on screening
• Patients who have definite history of depression or have taken antidepressants
• Patients who have been diagnosed as having bipolar disorder or other psychiatric disorders
• Patients with severe dementia or aphasia. However, those who have motor aphasia but are still communicable can be enrolled
• Patients who have taken migraine medication on screening or those who are expected to take migraine medication frequently due to severe migraine
• Patients who have strong suicidal idea on screening test or those who express their wish to be treated for depression
• Patients who are considered to be treated for depression by charged physicians
• Patients who need SSRI medication for other reasons
• Patients who have taken antiepileptic drugs on screening
• Patients who have a history of traumatic brain injury, brain tumor, or other brain disease (except stroke) within 30 days prior to screening
• Patients with uncommon causes of stroke (e.g. subarachnoid hemorrhage, venous thrombosis, arteriovenous malformation, or Moyamoya disease)
• Patients with bleeding diathesis, hemophilia, or thrombocytopenia
• Patients with severe concomitant illness (e.g. liver disease, renal disease, malignancy)
• Patients with abnormal blood tests Abnormal LFT (ALT > 200 or AST > 200) Anemia (Hb < 8 mg/dl) or thrombocytopenia (<100,000/mm3) Renal insufficiency (Cr > 3.0 mg/dl) or renal failure requiring dialysis Patients with severe heart failure (NYHA class III or IV) NYHA classification for heart failure Class I : patients with no limitation of activities; they suffer no symptoms from Ordinary activities Class II : patients with slight, mild limitation of activity; they are comfortable with rest or with mild exertion Class III : patients with marked limitation of activity; they are comfortable only at rest Class IV : patients who should be at complete rest, confined to bed or chair; any activity brings on
• Pregnant or lactating patients
• Patients who are participating in another clinical trial, but those who are participating in the observational study can be enrolled