CHICAGO - Doctors may want to give stroke victims antidepressants right
away instead of waiting until they develop depression, a common complication,
new research suggests.
The findings may lead to an expanded use for antidepressants. Someday high-risk
people like stroke patients might take the drugs before suffering depression -
just as people now take cholesterol drugs to prevent heart attacks, the lead
author said.
The researchers gave low doses of the antidepressant Lexapro to stroke patients.
The patients on the drug were 4.5 times less likely to develop depression than
patients taking a dummy pill.
More than 700,000 Americans suffer strokes each year and more than one-third
will develop depression in the next two years. Stroke patients with depression
recover more slowly and are more likely to die, according to previous research.
"We showed you could in fact prevent the development of depression after
stroke," said Dr. Robert Robinson of the University of Iowa who led the study.
"I hope I don't have a stroke, but if I do, I would certainly want to be placed
on an antidepressant."
Experts say strokes may damage parts of the brain affecting mood. Add to that
the stress of relearning simple tasks and adjusting to stroke-caused impairments
and you have a recipe for depression.
Lexapro may work by making the chemical serotonin more available in the brain
and by promoting brain repair, said Dr. George Bartzokis of the University of
California, Los Angeles, who was not involved in the new study.
"Treating the depression may actually help treat the stroke and vice versa,"
Bartzokis said.
The study, appearing in Wednesday's Journal of the American Medical Association,
was based on an analysis of 176 stroke patients, ranging in age from 50 to 90.
At the start, none suffered from depression. One-third were randomly assigned to
take Lexapro. One-third took matching dummy pills. And one-third were assigned
to receive talk therapy focusing on problem-solving skills.
After one year, about nine per cent of the Lexapro group had developed
depression. That compared to 22 per cent of the placebo-takers and 12 per cent
of the people who got problem-solving therapy.
Side-effects such as dry mouth, dizziness, rapid heart rate and sexual problems
were reported by all three groups at about the same rates.
Lexapro costs about $80 per month. A generic version of a similar drug costs
about $40 per month and might be as effective, Robinson said.
Dr. Charles Reynolds, a geriatric psychiatrist at the University of Pittsburgh
Medical Center, said he hopes doctors will start prescribing preventive
antidepressants to stroke patients.
"Depression in the wake of a stroke amplifies the suffering and disability such
patients experience," Reynolds said. "Dr. Robinson's work supports a novel way
of preventing such suffering and disability."
But with prevention, some patients take pills who never would have needed them,
putting them at risk for unnecessary side-effects. Seven stroke patients would
have to be treated with antidepressants to prevent one depression, the
researchers found.
Robinson said that's acceptable, especially when compared to the current
standards in heart attack prevention. He cited a study showing it takes 40 male
patients taking cholesterol-lowering statins over five years to prevent just one
heart attack.
The researchers excluded from the study patients who had cancer, other
life-threatening conditions or severe verbal impairments, so the findings may
not apply to all stroke patients.
The research was funded by the National Institute of Mental Health.
