Many people develop depression after stroke. Some studies found that antidepressant drugs prescribed after stroke were beneficial, while other studies were not able to find this effect. The current study included stroke patients; both depressed and nondepressed patients suffering from stroke were included. It was found that subjects who received antidepressants for three months after the stroke had reduced disability when compared to those who received placebo drugs containing no active ingredients. Thus, antidepressants might influence multiple chemicals in the brain called neurotransmitters and thereby facilitate the functional recovery of the brain.
Stroke is a disease caused by low blood circulation in the brain. It produces dysfunction of the areas affected by the altered blood circulation. Stroke limits the physical activity of a patient and this in turn increases the patient’s dependence on others. Ultimately, the patient’s quality of life is greatly affected; such patients may develop depression. The role of antidepressant drugs in recovery after stroke is controversial. Some studies showed beneficial results, while others did not find benefits of the antidepressant therapy. The current study was carried out on both depressed and nondepressed patients who suffered from stroke. It studied the effects of a three-month antidepressant therapy and reviewed the condition one year after the stroke.
* In this study, 46 subjects suffering from depression after going through a stroke were selected. Of these, 19 subjects received the drug fluoxetine, 10 subjects received nortriptyline, and 17 subjects received placebo.
* The other group consisted of 37 nondepressed stroke-affected subjects. Of these, 13 subjects received fluoxetine, 12 subjects received nortriptyline, and 12 subjects received placebo. The subjects were not aware of the type of therapy they were receiving.
* All the subjects were seen at enrollment of the study and at an interval of three, six, nine and 12 weeks and at six, nine and 12 months after the therapy.
* The mean age in the treatment group was 65.7 years. This value was 72.5 years for the placebo group.
* The severity of depression was measured on the Hamilton Depression Rating Scale (HDRS). Impairment in activity of daily life (ADL) was assessed by Functional Independence Measure (FIM) and disability was determined by the modified Rankin Scale (mRS).
* HDRS is used to determine severity of depression by symptoms like low mood, insomnia, agitation, anxiety, and weight loss. A score of more than 12 is considered indicative of depression. The baseline mean score in this study was 15.3 for the treatment group and 12.3 for the placebo group.
* The study showed that treatment with antidepressants for three months after the stroke significantly reduced the disability from stroke over one year.
* Some subjects received antidepressants for six months. However, there was no significant difference in the recovery of subjects who had been given antidepressants for three months when compared to those who had received them for six months.
* MRS scores indicate disability after a stroke. A score of “0” represents no symptoms/disability, while “5” indicates death. In this study, it was found that the subjects in the active treatment group gradually improved their mRS scores over time. However, the mRS scores of the placebo group changed little during the same period. Both fluoxetine and nortriptyline were effective for the recovery process.
The study included a majority of subjects who were high school graduates or college-educated, white and married. The findings of this study might not be applicable to different socioeconomic classes. Other factors like the level of rehabilitation care and the type of social support may have influenced the outcome. It is still not clear how antidepressants help in recovery of the stroke-affected brain. More research work in this direction would be useful.
This study found that treatment with antidepressants for three months after the stroke significantly reduces the disability associated with stroke over one year. This effect is independent of the age at the time of suffering from stroke, total hours spent in physical rehabilitation, and the severity of the stroke. This finding is important because reduced physical capability after a stroke increases the patient’s dependence on others. This leads to increased burden on the caregivers. Antidepressants might be doing more than controlling the depression. Through other neurotransmitters, they may be influencing the functional recovery of the brain. More research work would help in understanding these mechanisms. Thus, antidepressants could be a useful addition in rehabilitation strategies after a stroke.
For More Information:
Effect of Antidepressants on the Course of Disability Following Stroke
Publication Journal: American Journal of Geriatric Psychiatry, 2011
By Katsunaka Mikami, MD, PhD; Ricardo Jorge, MD; Carver College of Medicine, The University of Iowa, Iowa City
*FYI Living Lab Reports Are Summaries of the Original Research.