Preventing depression after stroke: Results from a randomized placebo-controlled trial

Unit of Geriatric Psychiatry, Royal Perth Hospital and University of Western Australia, Perth, Australia.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 07/2006; 67(7):1104-9. DOI: 10.4088/JCP.v67n0713
Source: PubMed


We designed this study to determine whether the daily treatment of nondepressed acute stroke patients with sertraline reduced the incidence of depression at follow-up.
111 patients with recent stroke (< 2 weeks; International Classification of Diseases, Tenth Revision criteria) were randomly assigned to treatment with placebo (N = 56) and sertraline (N = 55, 50 mg once daily) in this double-blind, placebo-controlled 24-week clinical trial. Subjects were recruited from the 2 largest teaching hospitals of Western Australia between June 2002 and June 2004. The primary endpoint of interest was development of clinically significant depressive symptoms as assessed by a Hospital Anxiety and Depression Scale-depression subscale score of 8 or above, or as diagnosed by the treating physician during 24 weeks.
There was no significant difference in the incidence of depressive symptoms during 24 weeks of treatment (16.7% [8/48] sertraline vs. 21.6% [11/51] placebo, rate ratio = 0.8, 95% CI = 0.3 to 2.1, p = .590). The trial medication was discontinued by 51.8% (29/56) of patients assigned placebo and 47.3% (26/55) assigned sertraline (p = .634), most often because of perceived side effects or because the treating physician introduced an antidepressant medication.
Twenty-four-week treatment with 50 mg of sertraline once daily initiated within 2 weeks of onset of acute stroke is not a significantly more effective strategy to prevent 6-month depression than usual care plus placebo among nondepressed stroke patients. New pharmacologic and nonpharmacologic strategies need to be developed to reduce the health and financial burden associated with depression after stroke.

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    • "incidence of PSD to be higher within 1 month than at later stages of the first year (Aben et al. 2002, 2003, 2006, Morrison et al. 2005, Leentjens et al. 2006, Nys et al. 2006). Others have shown that stroke survivors suffering from depression at an early stage are exposed to continued depression, poorer outcomes and increased functional dependence , or even mortality (Sinyor et al. 1986, van de Weg et al. 1999, Paolucci et al. 2001, Berg et al. 2003, Almeida et al. 2006, Nys et al. 2006, Gaete & Bogousslavsky 2008). "
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    ABSTRACT: The aim of the present study was to describe the lived experience of stroke survivors suffering from depressive symptoms in the acute phase; addressing the following questions: (a) what is the nature of depression as experienced by post-stroke patients in the acute phase? (b) what is it like to live with depression within the first weeks following stroke? Post-stroke depression occurs in at least one quarter of stroke survivors and is linked to poorer outcomes. This qualitative study is methodologically grounded in hermeneutic phenomenology, influenced by van Manen and Ricoeur. A descriptive, qualitative design was used applying in-depth interviews as the method of data collection with nine participants. The data collection took place in 2008. The material revealed two main themes that generate the feeling and description of 'living a life in shades of grey': (a) being trapped and (b) losing oneself. 'Shades of grey' could be understood as being confined in a new life-world and losing oneself as the person one knew. The participants confirmed suffering from depressive symptoms, but depression was not seen as meaningful on its own. They related their experiences of post-stroke depression in the acute phase to the losses they experienced. Nurses ought to take into account the depth of the life changes that stroke survivors may experience. There is a need for continued empirical research on how nurses may help and support stroke survivors dealing with depressive symptoms in the acute phase after stroke and how depressive symptoms develop over time.
    Journal of Advanced Nursing 11/2011; 68(8):1726-37. DOI:10.1111/j.1365-2648.2011.05855.x · 1.74 Impact Factor
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    • "A recent Cochrane review, evaluating data from nine trials (11 comparisons) involving different pharmaceutical agents, and three trials of psychotherapy, found no clear effect of either pharmacotherapy or psychotherapy on the prevention of depressive illness or disability (Anderson et al 2004). Moreover, data from a more recent trial showed that sertraline treatment, 50 mg/day, had no advantage in comparison to placebo in preventing PSD (Almeida et al 2006). "
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    ABSTRACT: Mood depression is a common and serious complication after stroke. According to epidemiological studies, nearly 30% of stroke patients develop depression, either in the early or in the late stages after stroke. Although depression may affect functional recovery and quality of life after stroke, such condition is often ignored. In fact, only a minority of patients is diagnosed and even fewer are treated in the common clinical practice. Moreover, the real benefits of antidepressant (AD) therapy in post-stroke depression have not been fully clarified. In fact, controlled studies on the effectiveness of ADs in post stroke depression (PSD) are relatively few. Today, data available suggest that ADs may be generally effective in improving mood, but guidelines for the optimal treatment and its length are still lacking.
    Neuropsychiatric Disease and Treatment 03/2008; 4(1):145-54. DOI:10.2147/NDT.S2017 · 1.74 Impact Factor
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    ABSTRACT: Key Points Depression is a common complication post-stroke affecting approximately one-third of patients. The risk factors associated with increased risk for post-stroke depression (PSD) include female sex, past history of depression or psychiatric illness, functional limitations, and cognitive impairment. Despite an abundance of research, the influence of stroke location on the risk for developing post-stroke depression has not been determined. Detection and diagnosis of post-stroke depression is often inconsistent and compliance with guidelines for screening is poor. Identified barriers to routine screening include time pressures and concerns about screening tools. Depression post-stroke has a negative impact on functional recovery. Post-stroke depression impacts negatively upon social activity and vice versa. Post-stroke depression is associated with cognitive impairment. The presence of mental health disorders post stroke is associated with increased risk for mortality. Early initiation of antidepressant therapy in non-depressed individuals is effective in preventing post-stroke depression. Ongoing, individualized contact and support may reduce the risk for deterioration of psychological health following stroke. Heterocyclic antidepressants improve post-stroke depression. SSRI antidepressants are effective in the treatment of post-stroke depression. Further study is required. Bright light therapy may be an effective adjunct to treatment with SSRI antidepressants. The Evidence-Based Review of Stroke Rehabilitation (EBRSR) reviews current practices in stroke rehabilitation.
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