Post-Stroke Depression Undertreated

Only 1 in 5 patients get antidepressants, study finds

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By Ed Edelson
HealthDay Reporter

THURSDAY, Sept. 28, 2006 (HealthDay News) -- While 17 percent of people who suffered strokes went on to develop depression, only a fifth of these patients ever received antidepressant drugs, a new Australian study found.

Those results "are a confirmation of things that have been suggested by other studies," and the same under-treatment almost certainly occurs in the United States, noted Daniel T. Lackland, a professor of epidemiology at the Medical University of South Carolina, a spokesman for the American Heart Association.

"Stroke patients suffering from depression have been found to have reduced quality of life and a higher rate of death, so it is important to identify and treat depression after stroke," study lead author Seana L. Paul, a researcher at the National Stroke Research Unit in Victoria, Australia, said in a statement.

Her team published its findings in the journal Stroke.

In the study, the Australian group visited 289 men and women in the five years after they had strokes, asking about any symptoms of depression and any medications they were taking.

They found that 17 percent of these stroke survivors were, in fact, suffering from depression. However, only 22 percent of those with depression were taking an antidepressant medication. Antidepressant medication provided some relief for 72 percent of those taking the drugs, the researchers found.

These medications do more than just lift moods, they added. "We know that stroke survivors who are not depressed live longer, higher-quality lives than those who are depressed," Paul said. "Consequently, educating physicians, stroke survivors and their families about the risk of depression after stroke may increase identification of depression and lead to improved treatment."

Failure to treat stroke survivors for depression might mean that doctors are not certain that antidepressants are effective and safe, she added. "Another factor may be that depression among stroke patients is not being diagnosed."

The Australian study confirms what is more or less common knowledge, according to Lackland. "One of the major things we know at the primary-care level is that people who have strokes are an at-risk group for depression," he said.

What's less clear is why depression so often goes untreated.

"It's probably a combination of a number of things," Lackland said. "One is that stroke patients are not being referred to psychiatrists. Probably depression just is not being assessed in the group. Their physicians are more concerned about other aspects of stroke, such as controlling blood pressure or diabetes or other factors."

In addition, someone who suffers a stroke "may be less enthusiastic about living than before," he said.

It is thus "very, very appropriate" for friends or relatives of the stroke patient to be alert for signs of depression and to suggest treatment, Lackland said.

The finding suggests the need for a large-scale controlled trial of antidepressant medication after a stroke, Paul said.

More information

A fact sheet on stroke and depression is available from the U.S. National Institute of Mental Health.

SOURCES: Daniel T. Lackland, Ph.D., professor, epidemiology, Medical University of South Carolina, Charleston; Sept. 28, 2006, news release, American Heart Association; Sept. 29, 2006, Stroke

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