Determinants of Antidepressant Treatment and Outpatient Rehabilitation Within the First Year After Stroke

Ladwig, Simon; Werheid, Katja

doi:10.1177/0891988720973749

Cited by 5 publications

(5 citation statements)

References 53 publications

(90 reference statements)

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“…ADT represents an ef-fective agent for PSD treatment [9][10][11][12] and is part of established stroke guidelines recommendations [14,15]. Moreover, previous studies showed an association between more severe PSD and higher treatment rates, possibly due to easier detection and a higher need [7,45]. Therefore, our findings indicate that with regard to severity, the mismatch between ADT and PSD might be more pronounced in later parts of the medical supply chain or clinical practice, which more likely do not have a primary focus on PSD and its consequences for stroke survivors.…”

Section: Discussionmentioning

confidence: 99%

“…Participants: Stroke survivors were recruited from two German rehabilitation centers. The examined participants stem from the prospective longitudinal "Berlin PSD study" (for a comprehensive description see [7,37]). Inclusion criteria were (1) occurrence of ischemic stroke diagnosed in medical record within six months before baseline assessment, (2) sufficient verbal comprehension as defined by a score of ≤12 error points in Aachener Aphasie Test (AAT) [38].…”

Section: Methodsmentioning

confidence: 99%

“…Systematic reviews show that post stroke depression (PSD) is associated with worse rehabilitation outcome and higher mortality [3,4]. Moreover, PSD has been found to prolong functional and vocational recovery, reduce life satisfaction [5], and render the use of rehabilitation services less efficient [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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Too Much and Too Little: Antidepressant Treatment in Stroke Survivors during the First Year

Werheid¹,

Volz²,

Ladwig³

et al. 2022

J. Integr. Neurosci.

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Background: Post-stroke depression (PSD) is the most frequent mental illness after stroke, affecting about 30% of stroke survivors and hampering rehabilitation outcome. While current guidelines recommend monitored antidepressant treatment (ADT) in PSD, the limited precision between the use and need of ADT in clinical practice remains underassessed and poorly understood. Methods: Depression according to DSM criteria and ADT was assessed in n = 294 stroke survivors from two German rehabilitation centers about one, six, and twelve months after stroke. At each measurement occasion, PSD and current use of ADT was assessed, leading to four subgroups: PSD (yes/no) and ADT (yes/no). Frequencies of ADT and PSD were examined and analyzed with regard to depression severity (minor/major). Intra-individual trajectories were used to assess the persistence in ADT over-and undertreatment from a longitudinal perspective. Results: After one, 6 and 12 months, 36.7%, 31.1% and 25.5% of stroke survivors fulfilled the criteria for depression. Across all measurement occasions, 53% of depressed stroke survivors did not receive ADT, while 12% of the non-depressed did. ADT between stroke survivors with major or minor depression differed at baseline but not thereafter. Between 15-40% of the depressed without ADT experienced persisting undertreatment and 25-50% the non-depressed with ADT had not fulfilled depression criteria at an earlier time point. Conclusions: Depression occurred in one in three stroke survivors. Among these, only one in two received ADT, irrespective of PSD severity after discharge. In contrast, one in eight stroke survivors without depressive disorder received ADT, about half of them in the absence of earlier PSD. In conclusion, we found evidence of both under-and overtreatment of PSD with ADT, which emphasizes the need for a more stringent implementation of current PSD guideline recommendations.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Too Much and Too Little: Antidepressant Treatment in Stroke Survivors during the First Year

Werheid¹,

Volz²,

Ladwig³

et al. 2022

J. Integr. Neurosci.

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“…This analysis is based on the data of two independent prospective longitudinal studies, the Berlin PSD study and the PoStDAM study (=Post-Stroke Depression: Early Assessment for improved Management). Both studies' procedures were previously described in detail ( 12 , 34 ) and are summarized in the following. Patient flow and reasons for drop-out are reported in Figure 1 .…”

Section: Methodsmentioning

confidence: 99%

Predictors of post-stroke depression: Validation of established risk factors and introduction of a dynamic perspective in two longitudinal studies

Ladwig

Werheid²,

Südmeyer³

et al. 2023

Front. Psychiatry

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IntroductionCerebral insults lead in many cases not only to cognitive impairment but also to disturbed emotionality. After stroke, one in three survivors develops a depression which impacts quality of life and rehabilitation. Meta-analyses have identified five main predictors of post-stroke depression (PSD): history of mental disorder, stroke severity, physical disability, cognitive impairment, and social support. However, these five established variables have never been conjointly investigated in a sample of stroke survivors. Therefore, their independent predictive values remain unclear. Moreover, predictors are most often used as time-invariant factors (status scores), neglecting the intraindividual dynamics after stroke.MethodsOur study analyses the data of two prospective longitudinal studies, investigating stroke survivors from two rehabilitation hospitals (N1 = 273) and one acute care hospital (N2 = 226). Baseline assessments included the five established predictors and depressive symptoms. After 6 months, depressive symptoms were reassessed in both studies (n1 = 176, n2 = 183), and physical disability and social support were reassessed in study 2. The predictivity of the five predictors and the additional predictivity of intraindividual dynamics for PSD were examined in multiple linear regression analyses.ResultsHistory of mental disorder was a risk factor for depressive symptoms after stroke at all measurement times (B = 3.32 to 3.97; p < 0.01). Physical disability was a risk factor at all measurement times (B = −0.09 to −0.03; p < 0.05) except 6 months after rehabilitation. Social support was a protective factor (B = −2.69 to −1.91; p < 0.01) outside the acute phase (R2 = 0.15–0.39). Intraindividual changes in physical disability and perceived social support were independent predictors of PSD 6 months after the acute phase (B = −0.08/−0.14; p < 0.01), in addition to status scores on established variables (ΔR2 = 0.08, p < 0.001).DiscussionHistory of mental disorder, physical disability, and social support are independent predictors of depressive symptoms in the first year post-stroke, also when considered conjointly. Future studies should control for these variables when investigating new predictors of PSD. In addition, intraindividual changes in known predictors after stroke play a relevant role in the pathogenesis of PSD and should be considered in clinical practice and future research.

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“…De manera más concreta, solo entre el 23 y el 49% de los supervivientes a un ictus que presentaron síntomas depresivos clínicamente relevantes habían recibido tratamiento antidepresivo en los 12 meses siguientes al ictus 25,36,38 . En aquellos pacientes con DPI tratados con antidepresivos, los resultados de diferentes estudios muestran una asociación entre mayor severidad de la DPI y mayores tasas de uso de antidepresivos, posiblemente debido a una mayor facilidad para su detección y una mayor necesidad de tratamiento 39 .…”

Section: Depresión Post-ictusunclassified

Uso de fármacos antidepresivos en neurología

García-Alberca

2023

KRANION

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La prescripción de antidepresivos está muy extendida en el ámbito de la neurología, aunque con frecuencia se limita al tratamiento de los síntomas depresivos que, con mucha frecuencia, se presentan asociados a distintas enfermedades neurológicas. Sin embargo es posible ampliar el foco de tal forma que su uso adecuado puede proporcionar al profesional beneficios adicionales en el curso de enfermedades prevalentes en esta especialidad. En este sentido, los antidepresivos constituyen en muchos casos una opción terapéutica eficaz que contribuye a mejorar la calidad de vida de los pacientes neurológicos.

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Determinants of Antidepressant Treatment and Outpatient Rehabilitation Within the First Year After Stroke

Cited by 5 publications

References 53 publications

Too Much and Too Little: Antidepressant Treatment in Stroke Survivors during the First Year

Too Much and Too Little: Antidepressant Treatment in Stroke Survivors during the First Year

Predictors of post-stroke depression: Validation of established risk factors and introduction of a dynamic perspective in two longitudinal studies

Uso de fármacos antidepresivos en neurología

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