Preventive Treatment May Ward Off Poststroke Depression

Main Category: Depression
Also Included In: Stroke / Neuroprotection;  Clinical Trials / Drug Trials
Article Date: 28 May 2008 - 0:00 PDT

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University of Iowa researchers have shown for the first time that an anti-depressant and a form of talk therapy each can prevent or delay the onset of depression in people who have had acute stroke.

The findings will appear in the May 28 issue of the Journal of the American Medical Association. Previous studies on this type of prevention had not shown positive results; however, this new study, in contrast, was larger and double-blinded. The research was funded by the National Institute of Mental Health, part of the National Institutes of Health.

"Prevention has been a goal of psychiatry for a long time," said the study's principal investigator Robert G. Robinson, M.D., professor and head of psychiatry at the University of Iowa Carver College of Medicine. "It is the first time a double-blinded randomized study has shown it is possible to prevent a psychiatric disorder in patients without previous illness."

The study involved 176 participants treated from July 2003 through October 2007 at University of Iowa Hospitals and Clinics, the University of Chicago, and the Burke Rehabilitation Hospital in White Plains, New York. Participants ranged in age from 50 to 90 and did not currently have depression. They began participation in the study within three months of having a stroke and received treatment for 12 months.

Participants were randomly assigned to one of three treatment groups: the antidepressant escitalopram (Lexapro), placebo (inactive substance) and Problem-Solving Therapy, a form of talk therapy developed for use in older people. Neither participants nor the researchers initially knew which patients received the antidepressant and which received the placebo, making it a "double-blind" study.

Approximately 22 percent of the participants on placebo developed depression. In comparison, only 8.5 percent of those who received the antidepressant developed depression, and 12 percent of those who received talk therapy developed depression.

Side effects from the drug treatment were benign, with no significant differences in side effects seen among the three groups. One limitation of the study was that it did not include post-stroke patients who had other life-threatening illness such as heart disease or cancer.

Previous research by Robinson, UI and other investigators has shown that depression following stroke is significantly associated with impaired physical and cognitive recovery and with increased death rates. According to an American Heart Association report published in the journal Circulation in 2006, nearly 700,000 people have a stroke each year in the United States. More than one in three stroke survivors develop depression, creating a significant health care challenge, Robinson said.

"When we look at the results of our current study -- that we can prevent the development of depression -- and our previous data on how antidepressants improve longer-term survival, we believe the implication is that the vast majority patients with acute stroke would benefit from receiving antidepressant treatment," said Robinson, who also holds the Paul W. Penningroth Chair of Psychiatry.

Robinson said, based on the findings, seven post-stroke patients would need to be given antidepressant to prevent one case of depression, and nine patients would need to receive talk therapy to prevent one case of depression. He noted, as a point of comparison, that among men with high cholesterol, 40 patients must be treated with a statin for five years to ward off one heart attack.

"With baby boomers aging, there will be an explosion in the elderly population, which is the group most likely to suffer stroke," Robinson said. "If we could prevent depression, which has previously been shown to have very negative consequences on stroke recovery, family support and rehabilitation efforts, and if we could also increase the long term survival, then it would be a major advance in the care of patients with stroke."

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