Neurology, Neuropsychiatry, Psychosomatics

Advanced search

The use of antidepressants in neurological practice

Full Text:


Antidepressants are widely used in neurological practice, and their use in stroke, Alzheimer's disease, depression with cognitive impairment, Parkinson's disease, multiple sclerosis, chronic back pain and chronic migraine is discussed. Antidepressants are used in the presence of severe depressive symptoms, which are observed in 20–30% of neurological patients. The effect of antidepressants is higher in case of combination with recurrent depression. Presence of episodes of depression before the development of a neurological disease, history of effectiveness of antidepressants, hereditary burden of affective disorders, characteristic daily dynamics of symptoms with typical impaired sleep architecture indicate the likelihood of a combined affective disorder. Final establishment of a psychiatric diagnosis is possible with a consultation of a neurological patient by a psychiatrist, but in clinical practice this is realistic only in a small number of patients. The most commonly used antidepressants are selective serotonin reuptake inhibitors, selective serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants in low or medium doses, the duration of their administration is usually at least 3-6 months. In neurological diseases, the effectiveness of only some drugs has been noted, many antidepressants have not been studied in neurological diseases, but this does not exclude their effectiveness. When prescribing antidepressants, it is necessary to take into account possible drug interactions and avoid those combinations that may cause adverse reactions. It is advisable to use antidepressants in complex therapy in combination with an educational program, cognitive behavioral therapy and kinesiotherapy. Many questions regarding the efficacy and safety of treatment, the choice of the optimal antidepressant, its dosage and duration of use require further study.

About the Author

V. A. Parfenov
N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation

Department of Nervous Diseases and Neurosurgery 

11, Rossolimo St., Build. 1, Moscow 119021

Competing Interests:

The investigation has not been sponsored. There are no conflicts of interest. The author is solely responsible for submitting the final version of the manuscript for publication. The author has participated in developing the concept of the article and in writing the manuscript. The final version of the manuscript has been approved by the author.


1. Liu G, Yang X, Xue T, et al. Is Fluoxetine Good for Subacute Stroke? A Meta-Analysis Evidenced From Randomized Controlled Trials. Front Neurol. 2021 Mar 22;12:633781. doi: 10.3389/fneur.2021.633781

2. Romanov DV, Petelin DS, Volel BA. Depression in neurological practice. Meditsinskiy sovet = Medical Council. 2018;(1):38-45. doi: 10.21518/2079-701X2018-1-38-45 (In Russ.).

3. Mosolov SN. Klinicheskoye primeneniye sovremennykh antidepressantov [Clinical use of modern antidepressants.]. St. Petersburg: Meditsinskoye informatsionnoye agentstvo; 1995. 568 p. (In Russ.).

4. Elzib H, Pawloski J, Ding Y, Asmaro K. Antidepressant pharmacotherapy and poststroke motor rehabilitation: A review of neurophysiologic mechanisms and clinical relevance. Brain Circ. 2019 Apr-Jun;5(2):62-7. doi: 10.4103/bc.bc_3_19. Epub 2019 Jun 27.

5. Chollet F, Tardy J, Albucher JF, et al. Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial. Lancet Neurol. 2011 Feb;10(2):123-30. doi: 10.1016/S1474-4422(10)70314-8. Epub 2011 Jan 7. Erratum in: Lancet Neurol. 2011 Mar;10(3):205.

6. Savadi Oskouie D, Sharifipour E, Sadeghi Bazargani H, et al. Efficacy of Citalopram on Acute Ischemic Stroke Outcome: A Randomized Clinical Trial. Neurorehabil Neural Repair. 2017 Jul;31(7):638-47. doi: 10.1177/1545968317704902. Epub 2017 Apr 28.

7. FOCUS Trial Collaboration. Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial. Lancet. 2019 Jan 19;393(10168):265-74. doi: 10.1016/S0140-6736(18)32823-X. Epub 2018 Dec 5.

8. Kalbouneh HM, Toubasi AA, Albustanji FH, et al. Safety and Efficacy of SSRIs in Improving Poststroke Recovery: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2022 Jul 5;11(13):e025868. doi: 10.1161/JAHA.122.025868. Epub 2022 Jun 22.

9. D'Anci KE, Uhl S, Oristaglio J, et al. Treatments for Poststroke Motor Deficits and Mood Disorders: A Systematic Review for the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Guidelines for Stroke Rehabilitation. Ann Intern Med. 2019 Dec 17;171(12):906-15. doi: 10.7326/M19-2414. Epub 2019 Nov 19.

10. Galts CPC, Bettio LEB, Jewett DC, et al. Depression in neurodegenerative diseases: Common mechanisms and current treatment options. Neurosci Biobehav Rev. 2019 Jul;102:56-84. doi: 10.1016/j.neubiorev.2019.04.002. Epub 2019 Apr 15.

11. Weintraub D, Rosenberg PB, Drye LT, et al; DIADS-2 Research Group. Sertraline for the treatment of depression in Alzheimer disease: week-24 outcomes. Am J Geriatr Psychiatry. 2010 Apr;18(4):332-40. doi: 10.1097/JGP.0b013e3181cc0333

12. Cumbo E, Cumbo S, Torregrossa S, Migliore D. Treatment Effects of Vortioxetine on Cognitive Functions in Mild Alzheimer's Disease Patients with Depressive Symptoms: A 12 Month, Open-Label, Observational Study. J Prev Alzheimers Dis. 2019;6(3):192-7. doi: 10.14283/jpad.2019.24

13. Takemoto M, Ohta Y, Hishikawa N, et al. The Efficacy of Sertraline, Escitalopram, and Nicergoline in the Treatment of Depression and Apathy in Alzheimer's Disease: The Okayama Depression and Apathy Project (ODAP). J Alzheimers Dis. 2020;76(2):769-72. doi: 10.3233/JAD-200247

14. Elsworthy RJ, Aldred S. Depression in Alzheimer's Disease: An Alternative Role for Selective Serotonin Reuptake Inhibitors? J Alzheimers Dis. 2019;69(3):651-61. doi: 10.3233/JAD-180780

15. Perini G, Cotta Ramusino M, Sinforiani E, et al. Cognitive impairment in depression: recent advances and novel treatments. Neuropsychiatr Dis Treat. 2019 May 10;15:1249-58. doi: 10.2147/NDT.S199746

16. Heser K, Bleckwenn M, Wiese B, et al; AgeCoDe Study Group. Late-Life Depressive Symptoms and Lifetime History of Major Depression: Cognitive Deficits are Largely Due to Incipient Dementia rather than Depression. J Alzheimers Dis. 2016 Aug 1;54(1):185-99. doi: 10.3233/JAD-160209

17. Galkin AS, Vasilyeva SN, Symutkin GT, et al. Changes in cognitive functions in patients with depressive disorders during selective serotonin reuptake inhibitors therapy. Sovremennaya terapiya psikhicheskikh rasstroystv = Current Therapy of Mental Disorders. 2021;(1):2-7. doi: 10.21265/PSYPH.2021.78.55.001 (In Russ.).

18. Connors MH, Quinto L, Brodaty H. Longitudinal outcomes of patients with pseudodementia: a systematic review. Psychol Med. 2019 Apr;49(5):727-37. doi: 10.1017/S0033291718002829. Epub 2018 Oct 15.

19. Goodarzi Z, Mrklas KJ, Roberts DJ, et al. Detecting depression in Parkinson disease: A systematic review and meta-analysis. Neurology. 2016 Jul 26;87(4):426-37. doi: 10.1212/WNL.0000000000002898. Epub 2016 Jun 29.

20. Hsu YT, Liao CC, Chang SN, et al. Increased Risk of Depression in Patients with Parkinson Disease: A Nationwide Cohort Study. Am J Geriatr Psychiatry. 2015 Sep;23(9):934-40. doi: 10.1016/j.jagp.2014.10.011. Epub 2014 Nov 6.

21. Devos D, Dujardin K, Poirot I, et al. Comparison of desipramine and citalopram treatments for depression in Parkinson's disease: a double-blind, randomized, placebo-controlled study. Mov Disord. 2008 Apr 30;23(6):850-7. doi: 10.1002/mds.21966

22. Menza M, Dobkin RD, Marin H, et al. A controlled trial of antidepressants in patients with Parkinson disease and depression. Neurology. 2009 Mar 10;72(10):886-92. doi: 10.1212/01.wnl.0000336340.89821.b3. Epub 2008 Dec 17.

23. Richard IH, McDermott MP, Kurlan R, et al; SAD-PD Study Group. A randomized, double-blind, placebo-controlled trial of antidepressants in Parkinson disease. Neurology. 2012 Apr 17;78(16):1229-36. doi: 10.1212/WNL.0b013e3182516244. Epub 2012 Apr 11.

24. Bomasang-Layno E, Fadlon I, Murray AN, Himelhoch S. Antidepressive treatments for Parkinson's disease: A systematic review and meta-analysis. Parkinsonism Relat Disord. 2015 Aug;21(8):833-42; discussion 833. doi: 10.1016/j.parkreldis.2015.04.018. Epub 2015 May 16.

25. Orayj K, Almeleebia T, Vigneshwaran E, et al. Trend of recognizing depression symptoms and antidepressants use in newly diagnosed Parkinson's disease: Population-based study. Brain Behav. 2021 Aug;11(8):e2228. doi: 10.1002/brb3.2228. Epub 2021 Jun 14.

26. Jones CD, Motl R, Sandroff BM. Depression in multiple sclerosis: Is one approach for its management enough? Mult Scler Relat Disord. 2021 Jun;51:102904. doi: 10.1016/j.msard.2021.102904. Epub 2021 Mar 18.

27. Fiest KM, Walker JR, Bernstein CN, et al; CIHR Team Defining the Burden and Managing the Effects of Psychiatric Comorbidity in Chronic Immunoinflammatory Disease. Systematic review and meta-analysis of interventions for depression and anxiety in persons with multiple sclerosis. Mult Scler Relat Disord. 2016 Jan;5:12-26. doi: 10.1016/j.msard.2015.10.004. Epub 2015 Oct 19.

28. Mohr DC, Boudewyn AC, Goodkin DE, et al. Comparative outcomes for individual cognitive-behavior therapy, supportive-expressive group psychotherapy, and sertraline for the treatment of depression in multiple sclerosis. J Consult Clin Psychol. 2001 Dec;69(6):942-9.

29. Ehde DM, Kraft GH, Chwastiak L, et al. Efficacy of paroxetine in treating major depressive disorder in persons with multiple sclerosis. Gen Hosp Psychiatry. 2008 Jan-Feb;30(1):40-8. doi: 10.1016/j.genhosppsych.2007.08.002

30. Stubbs B, Koyanagi A, Thompson T, et al. The epidemiology of back pain and its relationship with depression, psychosis, anxiety, sleep disturbances, and stress sensitivity: Data from 43 low- and middle-income countries. Gen Hosp Psychiatry. 2016 Nov-Dec;43:63-70. doi: 10.1016/j.genhosppsych.2016.09.008. Epub 2016 Sep 30.

31. Gerrits MMJG, van Oppen P, van Marwijk HWJ, et al. Pain and the onset of depressive and anxiety disorders. Pain. 2014 Jan;155(1):53-9. doi: 10.1016/j.pain.2013.09.005. Epub 2013 Sep 6.

32. Hung CI, Liu CY, Fu TS. Depression: An important factor associated with disability among patients with chronic low back pain. Int J Psychiatry Med. 2015;49(3):187-98. doi: 10.1177/0091217415573937. Epub 2015 Apr 30.

33. Kolber MR, Ton J, Thomas B, et al. PEER systematic review of randomized controlled trials: Management of chronic low back pain in primary care. Can Fam Physician. 2021 Jan;67(1):e20-e30. doi: 10.46747/cfp.6701e20

34. Urquhart DM, Wluka AE, van Tulder M, et al. Efficacy of Low-Dose Amitriptyline for Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Intern Med. 2018 Nov 1;178(11):1474-81. doi: 10.1001/jamainternmed.2018.4222. Erratum in: JAMA Intern Med. 2019 Mar 1;179(3):457.

35. Parfenov VA, Isaykin AI. Boli v poiasnichnoy oblasti [Pain in the lumbar region]. Moscow; 2018 (In Russ.).

36. Amiri S, Behnezhad S, Azad E. Migraine headache and depression in adults: a systematic review and meta-analysis. Neuropsychiatr. 2019 Sep;33(3):131-40. doi: 10.1007/s40211-018-0299-5. Epub 2019 Jan 21.

37. Asif N, Patel A, Vedantam D, et al. Migraine With Comorbid Depression: Pathogenesis, Clinical Implications, and Treatment. Cureus. 2022 Jun 16;14(6):e25998. doi: 10.7759/cureus.25998

38. Rampello L, Alvano A, Chiechio S, et al. Evaluation of the prophylactic efficacy of amitriptyline and citalopram, alone or in combination, in patients with comorbidity of depression, migraine, and tension-type headache. Neuropsychobiology. 2004;50(4):322-8. doi: 10.1159/000080960

39. MacGregor EA, Frith AA, Hackshaw A. Efficacy, safety, and tolerability of sertraline on depressive symptoms in women with comorbid migraine: an open-label study. J Clin Psychopharmacol. 2011 Jun;31(3):392-3. doi: 10.1097/JCP.0b013e3182189d70

40. Curone M, Tullo V, Savino M, et al. Outcome of patients with chronic migraine with medication overuse and depression after duloxetine: influence of coexisting obsessive compulsive disorder. Neurol Sci. 2013 May;34 Suppl 1:S175-7. doi: 10.1007/s10072-013-1376-y

41. Volpe FM. An 8-week, open-label trial of duloxetine for comorbid major depressive disorder and chronic headache. J Clin Psychiatry. 2008 Sep;69(9):1449-54. doi: 10.4088/jcp.v69n0912

42. Kostyukova EG, Mazo GE, Mosolov SN, et al. Bipolar affective disorder. Clinical guidelines. Adults. Electronic edition. Ministry of Health of the Russian Federation. Moscow; 2021. 245 p. Available from: (In Russ.).

43. Mosolov SN, Malin DI, Ryvkin PV, Sychev DA. Psychotropic Drugs Interaction. Sovremennaya terapiya psikhicheskikh rasstroystv. 2019;(S1):2-35. doi: 10.21265/PSYPH.2019.50.40828 (In Russ.).


For citations:

Parfenov V.A. The use of antidepressants in neurological practice. Neurology, Neuropsychiatry, Psychosomatics. 2023;15(2):4-9. (In Russ.)

Views: 228

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)