Antidepressant benefits in stroke

Antidepressant medication is given to a minority of stroke patients with depression, despite the treatment proving effective in almost three quarters of these patients, Australian research findings have suggested.

The study of 289 patients five years after a stroke found 17 per cent had depression. But only a fifth of these patients were taking antidepressants.  

Among those taking the anti-depressants, 72 per cent were no longer depressed when assessed.  

Lead researcher Dr Seana Paul, from the National Stroke Research Institute in Victoria, Australia, said: ‘Depression is common even five years after a stroke, and most of those taking antidepressant medication were not depressed, providing indirect evidence that the treatments are effective in stroke patients.’  

Uncertainty about side-effects and efficacy of antidepressants in patients recovering from stroke may explain prescriber caution over giving antidepressants to depressed stroke patients, the researchers suggested. It could also have been because depression was undiagnosed, non-pharmacological treatments were used or treatment had been stopped.  

Professor Allan House, an expert in psychiatry and behavioural science at the University of Leeds, said: ‘A conservative estimate is that 30 per cent of stroke survivors have their rehabilitation complicated by depression. You need to be careful if you’re going to use antidepressants with frail elderly people, but psychological and social interventions are underused because of the lack of availability to the physically ill elderly.’  

It is harder to diagnose depression after stroke because survivors can have difficulty communicating, as well as with facial expression, he said.  

Professor Gary Ford, stroke specialist at the University of Newcastle, said there was still a debate about whether depression after stroke was a reaction to related disability, or a result of neurological insult.  

‘There is probably a little of both,’ he said. ‘Those with more diffuse cerebral damage are at greater risk of depression.’ 

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