Journal article
Effect of Antidepressants on the Course of Disability Following Stroke
The American journal of geriatric psychiatry, Vol.19(12), pp.1007-1015
12/2011
DOI: 10.1097/JGP.0b013e31821181b0
PMCID: PMC3565535
PMID: 21358384
Abstract
Stroke often produces marked physical and cognitive impairments leading to functional dependence, caregiver burden, and poor quality of life. We examined the course of disability during a 1-year follow-up period after stroke among patients who were administered antidepressants for 3 months compared to patients given placebo for 3 months.
A total of 83 patients entered a double-blind randomized study of the efficacy of antidepressants to treat depressive disorders and reduce disability after stroke. Patients were assigned to either fluoxetine (N = 32), nortriptyline (N = 22) or placebo (N = 29). Psychiatric assessment included administration of the Present State Examination modified to identify DSM-IV symptoms of depression. The severity of depression was measured using the 17-item Hamilton Depression Rating Scale. The modified Rankin Scale was used to evaluate the disability of patients at initial evaluation and at quarterly follow-up visits for 1 year. Impairment in activities of daily living was assessed by Functional Independence Measure at the same time.
During the 1-year follow-up period, and after adjusting for critical confounders including age, intensity of rehabilitation therapy, baseline stroke severity, and baseline Hamilton Depression Rating Scale, patients who received fluoxetine or nortriptyline had significantly greater improvement in modified Rankin Scale scores compared to patients who received placebo (t [156] = −3.17, p = 0.002).
Patients treated with antidepressants had better recovery from disability by 1-year post stroke (i.e., 9 months after antidepressants were stopped) than patients who did not receive antidepressant therapy. This effect was independent of depression suggesting that antidepressants may facilitate the neural mechanisms of recovery in patients with stroke.
Details
- Title: Subtitle
- Effect of Antidepressants on the Course of Disability Following Stroke
- Creators
- Katsunaka Mikami - Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, IA 52242Ricardo E Jorge - Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, IA 52242Harold P Adams - Department of Neurology, Carver College of Medicine, The University of Iowa, Iowa City, IA 52242Patricia H Davis - Department of Neurology, Carver College of Medicine, The University of Iowa, Iowa City, IA 52242Enrique C Leira - Department of Neurology, Carver College of Medicine, The University of Iowa, Iowa City, IA 52242Mijin Jang - Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, IA 52242Robert G Robinson - Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, IA 52242
- Resource Type
- Journal article
- Publication Details
- The American journal of geriatric psychiatry, Vol.19(12), pp.1007-1015
- DOI
- 10.1097/JGP.0b013e31821181b0
- PMID
- 21358384
- PMCID
- PMC3565535
- NLM abbreviation
- Am J Geriatr Psychiatry
- ISSN
- 1064-7481
- eISSN
- 1545-7214
- Publisher
- Elsevier Inc
- Grant note
- R01-MH 40355; R01-MH65134 / This work is supported in part R01NS19632; 5U01NS041895 / Dr. Adams received research support from NIH-NINDS
- Language
- English
- Date published
- 12/2011
- Academic Unit
- Neurology; Psychiatry; Epidemiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984020760502771
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