Post-Stroke Depression, Antidepressant Treatment and Rehabilitation Results

Abstract

The aim of this study was to assess the specific influence of poststroke depression (PSD) on both basal functional status and rehabilitation results. We performed a case-control study in 290 stroke inpatients, matched for age (±1 year) and onset admission interval (±3 days) and divided in two groups according to the presence (PSD+) or absence (PSD–) of PSD. All PSD+ patients were treated with antidepressants (AD), mainly with fluoxetine. PSD+ patients, despite similar severity of stroke, showed greater disability in coping with activities of daily living (ADL) on admission and greater disability both in ADL and mobility at discharge than PSD– patients. Although both groups exhibited similar average functional improvement during rehabilitation, PSD– patients were nearly twice as likely to show excellent recovery both on ADL and mobility as PSD+ patients (OR = 1.95, 95% CI = 1.01–3.75 and OR = 2.23, 95% CI = 1.14–4.35, respectively). All AD drugs improved depressive symptoms. Few relevant side effects were observed: fluoxetine was discontinued in 2 patients because of insomnia and in 2 patients because of nausea; paroxetine was stopped in 1 patient because of nausea and dry mouth. Our results confirm the unfavorable influence of PSD on functional outcome, despite pharmacological treatment.

Fluoxetine and Sertraline Attenuate Postischemic Brain Injury in Mice

“…Post-stroke depression has negative effects on functional recovery (Parikh et al, 1990;Kotila et al, 1999), and these effects can be overcome by pharmacological treatment of depression (Gainotti et al, 2001). Although antidepressants have been effectively used to treat post-stroke depression (Primeau, 1988;Gainotti et al, 2001;Paolucci et al, 2001), their prescription is critically influenced by their safety, tolerability, and their impact on co-morbid conditions (Rampello et al, 2005).…”

Moderator and Mediator Effects of Personal Factors in Patients with Stroke

“…A report described that there was no relationship between the existence of PSD and the restoration of function 30) . However, it was demonstrated that a group without PSD achieved good restoration of ADL, two times better than a group with PSD 5) , and that the restoration of ADL was advanced by recovery from PSD 31) . Another study reports that the degree of restoration of ADL showed a difference of 30 percent according to whether or not treatment of PSD had been carried out 32) .…”

“…So far, age 2,3) , gender 4) , and depression 5) have been reported as factors influencing Activities of Daily Living (ADL).…”

Outpatient management after severe stroke with dementia

“…Постин-сультные депрессии встречаются значительно чаще других аффективных расстройств, чем объясняется повышенное внимание к этой проблеме уже многие годы [19,20]. Часто-та депрессии, по данным разных авторов [21][22][23][24], варьирует от 6 до 60%, составляя в среднем 20-30% .…”