Post-stroke depression increases risk of suicide and mortality

About one-third of patients suffer depression following a stroke, and depression in turn increases the risk of stroke, according to a review article by Loyola University Medical Center physicians.

Antidepressant medications known as SSRIs, such as fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro), are effective when given to stroke patients as a preventive measure, the physicians write in the journal Topics in Stroke Rehabilitation.

Authors are first author Murray Flaster, MD, PhD, who specializes in stroke care, and psychiatrists Aparna Sharma, MD, and Murali Rao, MD, who specialize in depression.
Mental disorders are common after stroke. They include anxiety, irritability and agitation, uncontrollable crying, apathy, delusions and hallucinations. But the most common disorder is depression, either major or minor.

Some patients recover over time, while others move in and out of depression. For some patients, depression doesn't develop until up to two years after the stroke.
Post-stroke depression (PSD) is linked to worse functional outcomes and increased risks of suicide and mortality.

Women are more likely to suffer PSD. Other risk factors include living alone and away from family members, higher levels of education, changes in lifestyle or marital status and degree of functional impairment. Depression, in turn, is a risk factor for stroke and stroke recurrence, even after controlling for other risk factors.

Given the severe effects of PSD, doctors should take an aggressive approach. Timing of medication may be crucial, with early treatment perhaps advantageous. In addition to helping relieve depression, antidepressants also have been shown to improve cognitive and functional recovery. Recent evidence also shows that SSRIs are helpful in motor recovery (improved movement and coordination).

"Taken together, the available data make a strong case for the prophylactic use and effectiveness of antidepressants post stoke," the authors write.

Flaster is an associate professor in the departments of Neurology and Neurological Surgery of Loyola University Chicago Stritch School of Medicine. Sharma is an assistant professor and Rao is a professor and chair of the Department of Psychiatry and Behavioral Neurosciences.

The title of their article is "Poststroke Depression: A Review Emphasizing the Role of Prophylactic Treatment and Synergy with Treatment for Motor Recovery."