Potential Options For Reducing Post-Stroke Depression

Editor's Choice
Main Category: Depression
Also Included In: Stroke
Article Date: 27 May 2008 - 13:00 PST

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An article published in the May 28 issue of JAMA reports that patients who took the drug escitalopram or participated in a problem-solving therapy group during the year following a stroke were found to have a lower risk of depression compared to patients who received placebo.

Of the over 700,000 incidences of stroke per year in the United States, more than half lead to depression. "Post-stroke depression has been shown in numerous studies to be associated with both impaired recovery in activities of daily living and increased mortality. Prevention of depression thus represents a potentially important goal," write author Robert. G. Robinson, M.D. (University of Iowa, Iowa City) and colleagues.

Testing the efficacy of the anti-depressant drug escitalopram or problem-solving therapy in comparison to placebo, Robinson and colleagues conducted a randomized controlled trial with 176 stroke patients. Within three months of the stroke, 59 patients were randomly assigned to take escitalopram for 12 months, 59 were assigned to the problem-solving therapy group, and 58 were assigned to the placebo group. In the problem-solving therapy group, patients received six treatment sessions and six reinforcement sessions; part of the program consisted of selecting a problem and working through steps to develop a plan of action.

The researchers found that depression had developed in 22.4% of patients in the placebo group, 8.5% in the escitalopram group, and 11.9% in the problem-solving therapy group. In other words, patients in the placebo group were 4.5 times and 2.2 times more likely to develop depression than the escitalopram and the problem-solving therapy group, respectively. The authors note that, "Based only on the frequency of depression onset during the one year of treatment, 7.2 acute stroke patients would need to be treated with escitalopram to prevent one case of depression and 9.1 acute stroke patients would need to be treated with problem-solving therapy to prevent one case of depression."

Using a more conservative method of data analysis, the researchers still found that escitalopram resulted in more favorable results than placebo - 23.1% of escitalopram patients developed depression compared to 34.5% in the placebo group. However, in these additional analyses, 30.5% of the problem-solving therapy group developed depression - not significantly better than placebo. Lastly, on significant difference among the groups was noted regarding the frequency of adverse events.

"The clinical implications of our findings are that patients who are given escitalopram or problem-solving therapy following acute stroke may be spared depression and perhaps its adverse consequences," conclude the authors.

Escitalopram and Problem-Solving Therapy for Prevention of Poststroke Depression: A Randomized Controlled Trial
Robert G. Robinson; Ricardo E. Jorge; David J. Moser; Laura Acion; Ana Solodkin; Steven L. Small; Pasquale Fonzetti; Mark Hegel; Stephan Arndt
JAMA (2008). 299[20]:2391 - 2400.
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Written by: Peter M Crosta
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