Antidepressants, from left, Wellbutrin, Paxil, Lexapro,
Effexor, Zoloft and Fluoxetine.
Stroke patients on Lexapro were
4.5 times less likely to develop depression, researchers say.
2004 Getty Images file photo
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# IF YOU SUSPECT A STROKE
If you believe someone has had a stroke, call 911 immediately.
Remember to act FAST:
F = Face
• Ask the person to smile. Does one side of the face droop?
A = Arms
• Ask the person to raise both arms. Does one arm drift downward?
S = Speech
• Ask the person to repeat a simple sentence. Are the words slurred? Can the person repeat the sentence correctly?
T = Time
• If the person shows any of these symptoms, time is important. Call 911 or get to the hospital fast. Brain cells are dying.
Source: National Stroke Association
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By Marilyn Elias, USA TODAY
SAN FRANCISCO (USA Today), May 27, 2008:
Preventive use of antidepressants slashes the depression rate of stroke patients by more than half and could help them live years longer, a landmark study out Tuesday suggests.
It's the first randomized, controlled research to show that treatment for depression for stroke victims who haven't displayed symptoms of depression can lead to significant fewer becoming depressed within a year.
And that may improve survival. Evidence suggests that being depressed after suffering a stroke triples the odds of dying up to 10 years later, says Thomas Insel, director of the National Institute of Mental Health.
In the study of 149 patients, one-third got the antidepressant Lexapro, one-third participated in problem-solving therapy and the rest received sugar pills. After a year, 22% who took placebos were depressed compared with 9% given antidepressants and 12% who attended therapy.
The study, reported in The Journal of the American Medical Association, was funded by the mental health institute.
Some reports suggest more than half of stroke survivors will develop depression within two years, says Robert Robinson, the study leader and psychiatry department head at University of Iowa College of Medicine in Iowa City.
Three earlier, smaller studies didn't find that preventive treatment lowered rates of depression in stroke victims. Those studies had older people. In the new one, patients were in their early 60s on average, which might partly account for the better result, Insel says.
Physical and cognitive recovery lag when a stroke patient is depressed, Robinson says.
In view of the new findings, "I think every stroke patient who can tolerate an antidepressant should be given one to prevent depression," he says.
Insel disagrees. "This is a valuable advance, but we can't change health care policy based on a single study."
He favors larger, longer and randomized research that looks at how antidepressants affect survival before the pills are given preventively to stroke patients.
The problem-solving therapy used in the study also is worth considering after strokes, "but we find most people would rather just take a pill," Insel says.
Nobody is sure why stroke survivors are prone to depression, but it's likely due to biology and life circumstances, Robinson says. Losing mobility or brain function can trigger depression. There's also evidence that those whose strokes injure one area on the left side of their brain are particularly apt to become depressed, so the brain injury itself could cause depression, he says.
Depression may shorten life because patients won't take medicine or go to rehab. Dangerous biological effects also can occur. For example, depression can spur heart arrhythmias and cause the heart to beat at a less variable rate, which leads to cardiac problems, Robinson says.
" If someone does become depressed after a stroke, they need really aggressive treatment," Insel says. "Family members should not just accept it as inevitable."
Copyright 2008 USA TODAY
