Antidepressants after a stroke

Question:

My wife just had a stroke and depression is a concern for our doctor, who wants to give her an antidepressant right away. Shouldn’t we wait to see if she even gets depressed?  

Answer:

Your doctor might be responding to a recent year-long study of 176 stroke patients funded by the National Institute of Mental Health that found that only nine percent of patients who received an antidepressant immediately following a stroke became depressed, while 22 percent of those who received a placebo (sugar pill) did. People who received neither pill, but attended therapy sessions did rather well, with only 12 percent becoming depressed. This is the first randomized, control study of its kind. 

Dr. Robert Robinson, the Head of Psychiatry at the University of Iowa Carver College of Medicine, led the research team. He reports that more than half of stroke survivors develop depression within two years, in part because of the emotional struggle related to losing their ability to function independently. Dr. Robinson and others suspect that the connection between stroke and depression is also linked to whether or not the stroke has damaged parts of the brain that affect mood, so the cause could be biological as much as it is behavioral.

Dr. Roger Cadieux, a geriatric psychiatrist affiliated with Hershey Medical Center, agrees with Dr. Robinson’s view that there’s no sense in waiting to provide antidepressants and stroke survivors need to use them prophylactically. Since the risks are pretty high that people suffering from a stroke will become depressed, why not take a preemptive strike? In Dr. Cadieux’s words, “If we could treat patients with antidepressants as soon as they stabilize from the stroke, it would prevent a great deal of emotional distress later on in the course of their illness and facilitate their rehabilitation.”

Others caution that a larger study is needed to confirm the finding that stroke and depression are related. What’s encouraging, though, is the study’s finding that therapy was also very effective in preventing depression. Although therapy should be prescribed quickly as part of the normal course of treatment rather than waiting for the patient (or his or her family members) to ask for it, it doesn’t always happen, so you should ask your doctor.

According to the American Heart Association, about 780,000 people suffer a stroke every year and more than one-third will develop depression within 24 months, causing them further debilitation. Depression blocks progress towards recovery and increases the likelihood of death. Your wife’s doctor is being proactive by providing antidepressants as stroke patients do have the odds stacked against them. If you are uncomfortable about the antidepressant, bring it up with her physician and ask if your wife would be a good candidate for therapy. But before you take that step, see if this is the course your wife wants to take.