Depression and Stroke

Dr. Robinson started his talk by summarizing the results of a recent study by Rasmussen and colleagues, which demonstrated the incidence of poststroke depression could be significantly reduced by sertraline treatment. This study was particularly interesting in that all the subjects were not depressed on study entry, and so all patients were treated prophylactically.

A treatment effect was present by about week 18, and sertraline treatment also decreased the incidence of adverse events, in particular the occurrence of cardiovascular events. However, an earlier study with mianserin was unable to show any reduction in the rate of poststroke depression relative to placebo, although the rate of depression in the placebo group was fairly low in this study, which may have made it difficult to see any effect of active treatment.

Depression

Depression is the most common psychological problem in the US. Minor Depression can be attributed to normal depressed feelings that arise because of a specific life situation, a side effect of medication, hormonal changes or physical illness, and does not usually require treatment. Major Depression (depressive illness) is a serious condition that result in extreme fatigue, sleep problems and eventually an inability to function. The exact cause is unknown, but it is thought to be a malfunction of brain neurotransmitters, which are chemicals that modulate moods. Major Depression is usually treated with a combination of psychotherapy and antidepressants which moderate or correct chemical imbalances in the brain. The group of antidepressants most frequently prescribed is the selective serotonin reuptake inhibitors (SSRIs) which regulate the neurotransmitter serotonin.

Examples:

Amitriptyline HCL
WELLBUTRIN
Wellbutrin SR
Fluoxetine
Celexa
Lexapro
Paxil
Prozac
Remeron
Zoloft
Effexor XR

When depression is present in stroke patients, it is associated with a significantly worse outcome. A diagnosis of depression 3 months after stroke has been shown to be associated with much poorer functioning at 15 months and a much slower rate of recovery. A diagnosis of depression at 1 month after a stroke has also been demonstrated to be a significant predictor of mortality at both 12 and 24 months. Even more surprising, Dr. Robinson presented some unpublished data that 3 months of SSRI treatment poststroke significantly reduced the death rate, even if the patients were not depressed. There was approximately a 50% increase in survival in SSRI-treated patients, most likely due to a decreased rate of adverse cardiovascular events.