An unselected cohort of 285 stroke patients, median age 69 years, were studied for correlation between potential risk factors and the 1-year incidence of post-stroke depression (PSD). The following factors correlated significantly with PSD: a history of previous stroke, a history of previous depression, female gender, living alone and social distress prestroke. Further, social inactivity, decrease in social activity, pathological crying and intellectual impairment at 1 month but not functional outcome correlated to PSD. A multivariate regression analysis showed that intellectual impairment explained 42% of variance of mood score. Major depression was unrelated to lesion location. We conclude that etiology to PSD is a complex mixture of prestroke personal and social factors, and stroke induced social, emotional and intellectual handicap.

The study is a validation study of two psychogeriatric depression rating scales, The Geriatric Depression Scale (GDS) and the Cornell Scale for Depression in Dementia (CSDD). The sensitivity and specificity, and the convergent and criterion validity of the two scales as well as the inter-rater reliability of the CSDD are reported. Two independent clinicians using the ICD-10 for depression and dementia, the Clinical Global Impression (CGI), the Hamilton Depression rating scale 17-items and the Mini-Mental-State Examination (MMSE), interviewed each patient or control subject. One hundred forty-five persons of 65 years or more of age were included, 73 were depressed only, 36 depressed and demented; 36 persons were control subjects, 11 of these were demented. The inter-rater reliabilities were high or very high equalling perfect correlation. There was very high convergent validity between the screening tools and the severity scales; the shorter versions of the GDS (15-, 10- or four-item version) had lower though still almost perfect correlations. The criterion validity in the total population showed the CSDD as the better scale with sensitivity and specificity of 93% and 97% with a cut-off value of > or =6. The GDS versions had sensitivities and specificities ranging from 82% to 90% and 75% to 94% respectively with cut-off values > or =9, 4, 3 and 1. The CSDD retained its validity and specificity as a screening tool for depression in a population of demented, while the GDS versions all diminished in validity. The GDS and the CSDD are both valid screening tools for depression in the elderly; however, the CSDD alone seems to be equally valid in populations of demented and non-demented.

Background and Purpose The aim of the study was to investigate the efficacy and safety of the selective serotonin reuptake inhibitor citalopram in treating poststroke depression, since available treatments are usually poorly tolerated.Methods A 6-week double-blind, placebo-controlled trial was undertaken. Diagnosis and outcome were determined using the Hamilton Depression Scale, and unwanted effects were measured using the UKU side effect rating scale. Sixtysix consecutive depressed patients from an unselected population of 285 stroke patients aged 25 to 80 years entered the trial 2 to 52 weeks after stroke. They were assigned to equally sized treatment and placebo groups. The initial level of depression was comparable in the two groups (mean baseline Hamilton Depression scores, 19.4 and 18.9, respectively). Demographic parameters were also comparable in the two groups.Results Significantly greater improvement was seen in patients treated with citalopram (10 to 40 mg/d) for 3 and 6

This study describes the development of post-stroke depression (PSD) prospectively during the first year post-stroke in 285 unselected stroke patients. An appropriate unselected population-based control group without cerebral pathology is included for comparison. Psychiatric assessment with the Hamilton Depression Rating Scale (HDRS) was undertaken unmodified. PSD was defined as HDRS > or = 13. The one-year incidence of PSD among the 209 survivors able to communicate reliably at 1 month was 41%. Most cases develop within the first months following stroke (79%), the frequency of new cases of PSD at one year being 5%, a level comparable to that in the control group. Depressed and nondepressed stroke patients consistently scored 4 points greater on total HDRS than in the corresponding controls.

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