The development of depression after a stroke is a serious condition that can have negative effects on thought, emotions, and overall daily functioning, particularly in the first year following the stroke. Evidence suggests that antidepressants may be used to prevent post-stroke depression. This study will treat nondepressed stroke patients with antidepressants or problem solving therapy (PST) to determine the most effective treatments for preventing depression.

Participants in this study will be randomly assigned to receive PST, escitalopram, or placebo (an inactive pill) for 12 months. Participants who display depressive symptoms for 2 weeks or more will be removed from the study. After 12 months, treatment will be discontinued and participants will be monitored for an additional 6 months.

Inclusion Criteria:

• Stroke within the last 120 days

Exclusion Criteria:

• DSM IV criteria for major or minor depressive disorder
• Heart, respiratory, kidney, or liver failure; severely disabling musculoskeletal disorder; or cancer
• Diagnosis of neurodegenerative disorders such as Parkinson’s disease, Alzheimer’s disease, Multiple System Atrophy, or Huntington’s disease
• Pre-existing dementia or aphasia with severe language comprehension deficits
• Alcohol or substance abuse or dependence within the last 12 months
• Recurrent unipolar or bipolar disorder prior to the stroke