Summary

Depression after a stroke is common and it can delay a patient's recovery. But antidepressant medication or problem-solving therapy can help ward off depression after a stroke. Therefore, it may be worth looking at these preventive measures as part of the stroke rehabilitation process.

Introduction

Depression may affect up to one third of stroke survivors. It must be taken seriously because it can slow down the recovery process. Depressed stroke survivors find more problems with activities of daily living and they also have an increased mortality. There is some evidence that treating stroke survivors before they develop depression can be helpful in reducing the risk. So-called preventive intervention is a strategy which involves giving treatment before diagnosis - and it is a relatively new approach. Researchers at the University of Iowa and elsewhere now report on a new study on how the antidepressant drug escitalopram and problem-solving therapy can prevent depression in a large group of stroke survivors.

What was done

A group of 176 stroke patients took part, within three months of having their stroke. They received either escitalopram, problem-solving therapy, or placebo for one year. The problem-solving therapy consisted of six treatment sessions and six reinforcement sessions in which participants chose a problem and went through steps to arrive at a solution. Depression was diagnosed using the standard questionnaire technique.

What was found

Patients receiving either kind of treatment were less likely to develop depression compared to those on placebo. For escitalopram, the risk was 4.4 times less than on placebo, for problem-solving therapy it was 2.2 times less.

What this study means

There has been a long-standing interest in preventive intervention in psychiatry and this is the first time it has been shown, by a double-blind study, that it can actually work. Given that stroke survivors with depression go on to have an increased mortality rate, these findings have important implications. It is not yet clear how escitalopram and problem-solving therapy actually prevent depression. Nor is it yet known whether this kind of prevention is better, in the long term, than early diagnosis and treatment. However, at present, the majority of cases of depression in stroke survivors are not detected early - therefore, prevention may well be a better approach.