Prevention Of Poststroke Depression Research Articles

Depression and Stroke: Cause or Consequence?

Depression after stroke is common. Although different opinions exist about the definition, diagnosis, and measurement of outcomes related to depression after stroke, there is little debate about the prevalence of depression symptoms and their impact on stroke survivors and their families. Depression after stroke has long been recognized as a common condition with many negative effects in the poststroke period, but more recently depression has also been identified as an independent stroke risk factor. Given that there are at least 500,000 new ischemic strokes yearly in the United States, a conservative estimate is that 150,000 U.S. stroke survivors develop poststroke depression each year. Because effective treatments exist but are likely underutilized for depression, this is an important example of an evidence-practice gap to which increased efforts to improve care should be made. Such efforts would likely improve not only patient symptoms but may also decrease stroke risk, influence stroke functional recovery, decrease mortality, and reduce poststroke health care utilization. This article provides an overview of depression diagnosis in stroke, reviews the epidemiology of poststroke depression and its associated morbidity and mortality, and reviews existing evidence on the treatment and prevention of poststroke depression.

A Double-Blind, Placebo-Controlled Study of Sertraline in the Prevention of Depression in Stroke Patients

The authors tested the effect of sertraline in the prevention of poststroke depression. After experiencing an acute ischemic stroke, nondepressed patients (N=137) were randomly assigned to 12 months of double-blind treatment with either sertraline (N=70) or placebo (N=67). Kaplan-Meier analysis showed sertraline to have significantly superior prophylactic efficacy compared with placebo. Two definitions of clinical depression were used: total score >18 on the HAM-D(17) and score >or=9 on the HAM-D(6). Approximately 10% of the sertraline-treated group developed depression according to either definition, whereas 30% developed depression in the placebo group. On the HAM-D(6) the superiority of sertraline to placebo was demonstrated already after 6 weeks of therapy. Treatment was well tolerated; patients treated with sertraline experienced significantly fewer adverse events.

Stroke-related depression.

Stroke represents a major health problem in the United States and most European and Asian countries. Depression is probably the most common and serious emotional disorder following stroke. Post-stroke depression (PSD) has frequently been overlooked and left untreated. Prevention of PSD or successful intervention in the early phase may prevent premature deaths as well as facilitate rehabilitation, reduce costs, and improve quality of life. Stroke is clearly a risk factor for depression, and recent evidence suggests that depression increases the risk for stroke, although the mechanisms by which depression leads to stroke remain to be clarified. Once PSD has developed, numerous studies have documented its adverse effect on cognitive recovery, physical recovery, and mortality. Taken together, these studies support the necessity of identifying and treating this condition.

Post-stroke depression, not to be underestimated

Depression occurs in almost half of stroke survivors, 1 Kotila M Numminen H Waltimo O Kaste M Depression after stroke: results of the FINNSTROKE Study. Stroke. 1998; 2: 368-372 Crossref Scopus (330) Google Scholar yet H Palomäki and colleagues 2 Palomäki H Kaste M Berg A et al. Prevention of poststroke depression: 1 year randomised placebo controlled double blind trial of mianserin with 6 month follow up after therapy. J Neurol Neurosurg Psychiatry. 1999; 66: 490-494 Crossref PubMed Scopus (105) Google Scholar found that the disorder was neither common nor responsive to mianserin treatment in their trial among 100 consecutive patients with ischaemic stroke. They found that, according to DSM-IIIR criteria, major depression was present in 6% at the initial stage, 11% at 1 year, and 18% at 18 months. Mianserin, a tetracylic antidepressant, had no effect on depression or functional outcome as measured by the Rankin scale or the Barthel index. DEPARTMENT OF ERRORCan growth hormone therapy cause diabetes?—In this Correspondence letter by J P Monson and colleagues (May 13, p 1728), the third sentence of the third paragraph should be, “His warnings about the placebo effect of GH replacement (his use of the word tainted is rather curious) on improved wellbeing are overstated, particularly in view of the continued improvement in wellbeing, which is observed between 6 months and 12 months of treatment.5” Also, reference 3 should not be cited in the first paragraph. Full-Text PDF

Prevention of poststroke depression: 1 year randomised placebo controlled double blind trial of mianserin with 6 month follow up after therapy

OBJECTIVES(1) To test whether early prophylactic antidepressive treatment by mianserin is able to prevent poststroke depression, and (2) to discover whether mianserin as an antidepressant has any beneficial influence on...