# The impact of levodopa on post-stroke depression: the ESTREL-depression-study

## TL;DR

This study found that levodopa treatment during in-hospital stroke rehabilitation did not reduce the risk of post-stroke depression compared to a placebo.

## Contribution

The study provides new evidence that levodopa does not affect the occurrence of post-stroke depression in patients.

## Key findings

- Levodopa treatment did not reduce the frequency of post-stroke depression compared to placebo.
- The odds of developing post-stroke depression were similar between the levodopa and placebo groups.

## Abstract

Post-stroke depression (PSD) frequently occurs after acute stroke and negatively affects rehabilitation. Dopamine has beneficial effects on motivation and emotional stability. In stroke patients, low dopamine levels are linked to PSD. This study investigated whether levodopa treatment during in-hospital rehabilitation impacts PSD compared to placebo.

ESTREL-Depression was a pre-planned analysis of the multicenter, randomized, double-blind, placebo-controlled ESTREL trial. Participants with an acute ischemic or hemorrhagic stroke were randomly assigned to receive either levodopa/carbidopa (100/25 mg) or placebo three times daily for 39 days. All ESTREL participants with (1) information about the presence or absence of depression at three months and (2) who took at least 80% of the study medication were eligible for the study. Participants with a history of depression were excluded. For the primary outcome, the presence of PSD was defined as having a T-score of ≥55 in the Patient-Reported Outcomes Measurement Information System short-form depression-4a 3 months after randomization. Binary logistic regression was performed to assess the effect of levodopa on PSD.

The study included 407 ESTREL participants (median age 72, 60% male), 209 receiving levodopa, and 198 receiving placebo. At 3 months, the frequency and odds of PSD did not differ between the levodopa group (26%) and the placebo group (28%) (OR = 0.93, 95% CI, 0.60–1.43).

In the ESTREL-Depression study, treatment with levodopa had no impact on the occurrence of PSD.

ClinicalTrials.gov: NCT03735901 (https://clinicaltrials.gov/study/NCT03735901).

Graphical Abstract