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Preventive Treatment May Help Head Off Depression Following a Stroke

Science Update

For the first time, researchers show that preventive treatment with an antidepressant medication or talk therapy can significantly reduce the risk or delay the start of depression following an acute stroke, according to a study funded by the National Institute of Mental Health (NIMH), part of the National Institutes of Health. These findings differ from past studies attempting to prevent poststroke depression. The study appears in the May 28, 2008, issue of the Journal of the American Medical Association.

“Post stroke depression can impede rehabilitation and recovery of functional skills, reduce quality of life, and may also shorten a person’s lifespan,” notes NIMH Director Thomas R. Insel, MD. “Thus, early detection and intervention, in addition to preventive methods, are important components of post stroke treatment.”

Robert G. Robinson, M.D., of the University of Iowa, and colleagues compared the effects of the antidepressant medication escitalopram (Lexapro) with placebo (sugar pill) in 117 adults, ages 50-90, who had suffered an acute stroke within the previous three months. Neither the participants nor the researchers knew who was receiving the medication or a placebo during the study. Another group of 59 adults were randomly selected to receive Problem Solving Therapy (PST), a talk therapy that helps people identify problems that interfere with daily living and contribute to depressive symptoms and then develop strategies to solve those problems. None of the participants had depression at the start of the study.

The researchers tested escitalopram because previous research had shown that it worked quickly and effectively and could be tolerated over the 12-month study period. They chose PST over other forms of talk therapy because it was developed for use in older people.

People who received either escitalopram or PST were less likely to develop depression (8.5 percent and 11.9 percent, respectively) than those who received the placebo (22.4 percent). 

This is the first study of its kind to show some cases of post stroke depression can be prevented with intervention. In addition to the need for further studies, greater attention needs to be given to improving the early detection of and interventions for depression during standard stroke care, the researchers say.

Reference

Robinson RG, Jorge RE, Moser DJ, Acion L, Solodkin A, Small SL, Fonzetti P, Hegel M, Arndt S. Escitalopram and problem solving therapy for prevention of poststroke depression: A randomized trial . JAMA. 2008 May 28;299(20):2391-2400. PMID:18505948