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Therapies
appear helpful in reducing risk of
Depression following Stroke
Newswise — In the year following a stroke,
patients who received the medication
escitalopram or participated in a
problem-solving therapy group had a lower
risk of depression compared to patients who
received placebo, according to a study in
the May 28 issue of JAMA.
The annual incidence of stroke exceeds
700,000 in the U.S. Depression occurs in
more than half of these patients, according
to background information in the article.
“Post-stroke depression has been shown in
numerous studies to be associated with both
impaired recovery in activities of daily
living and increased mortality. Prevention
of depression thus represents a potentially
important goal,” the researchers write.
Robert. G. Robinson, M.D., of the University
of Iowa, Iowa City, and colleagues assessed
the efficacy of the anti-depressant drug
escitalopram or problem-solving therapy
compared with placebo pills for the
prevention of depression among 176 stroke
patients.
Within three months following the stroke,
the patients were randomized for 12 months
into one of three groups: escitalopram (n =
59); problem-solving therapy group (n = 59);
or placebo (n = 58).
The problem-solving therapy group consisted
of six treatment sessions and six
reinforcement sessions and included patients
selecting a problem and going through steps
to arrive at a course of action.
The researchers found that participants who
received placebo were 4.5 times more likely
to develop depression than patients who
received escitalopram (22.4 percent vs. 8.5
percent), and 2.2 times more likely to
develop depression than patients who
received problem-solving therapy (11.9
percent).
“Based only on the frequency of depression
onset during the one year of treatment, 7.2
acute stroke patients would need to be
treated with escitalopram to prevent one
case of depression and 9.1 acute stroke
patients would need to be treated with
problem-solving therapy to prevent one case
of depression,” the authors write.
An alternative, more conservative method of
analyzing the data found that escitalopram
was superior to placebo (23.1 percent vs.
34.5 percent), while problem-solving therapy
was not significantly better than placebo
(30.5 percent vs. 34.5 percent).
There was no significant difference between
groups in the frequency of adverse events.
“The clinical implications of our findings
are that patients who are given escitalopram
or problem-solving therapy following acute
stroke may be spared depression and perhaps
its adverse consequences,” the authors
conclude.
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