Abstract T MP45: Incidence, Predictors And Mortality Related To Post-stroke Antidepressant Treatment

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Janne K Mortensen ◽  
Heidi Larsson ◽  
Søren P Johnsen ◽  
Grethe Andersen
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Cox Regression ◽  
Antidepressant Treatment ◽  
Strong Predictor ◽  
Stroke Severity ◽  
Stroke Registry ◽  
Post Stroke ◽  
Kaplan Meier ◽  
Post Stroke Depression ◽  
Mean Time

Objective: To examine incidence, predictors and mortality related to antidepressant treatment after ischemic stroke in a clinical setting. Methods: Patients were identified from the Danish Stroke Registry which holds information on antidepressant treatment due to post stroke depression (PSD) and pathological crying (PC) from 2003-2010. Treatment initiation and mortality were analyzed using Kaplan-Meier curves and Cox regression. Potential predictors of antidepressant treatment were identified using multiple logistic regression. Results: Among 5070 first ever stroke patients without prior antidepressant treatment, 32.5% were treated with antidepressants within six months after stroke, primarily with selective serotonin reuptake inhibitors. Approximately half of the treated patients started treatment during stroke admission (mean time after stroke: 7 days for PC and 10 days for PSD). The vast majority of treated patients started treatment within 90 days (86%). Among patients treated during admission 93.1% redeemed at least one prescription after discharge. The predictor most strongly associated with treatment was stroke severity. The adjusted hazard ratio of death was 0.39 (95% CI: 0.31-0.48) for treated patients as compared to non-treated patients. Conclusion: Antidepressant treatment after stroke was common and often initiated early. Although increasing stroke severity was a strong predictor of antidepressant treatment, treatment was associated with a lower mortality.

Risk and Predictors of Depression Following Acute Ischemic Stroke in the Elderly

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000011828
Author(s):  
Naomi Mayman ◽  
Laura Katherine Stein ◽  
John Erdman ◽  
Alana Kornspun ◽  
Stanley Tuhrim ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cox Regression ◽  
Cumulative Risk ◽  
The Elderly ◽  
Stroke Patients ◽  
Post Stroke ◽  
Medicare Data ◽  
Kaplan Meier ◽  
Post Stroke Depression ◽  
History Of

Objective:We sought to comprehensively evaluate predictors of PSD in the US and compare PSD to post-myocardial infarction (MI) depression, in order to determine whether ischemic stroke (IS) uniquely elevates risk of depression.Methods:This is a retrospective cohort study of 100% de-identified inpatient, outpatient, and subacute nursing Medicare data from 2016-2017 for US patients aged ≥65 years from July 1, 2016 to December 31, 2017. We calculated Kaplan-Meier unadjusted cumulative risk of depression up to 1.5 years following index admission. We performed Cox regression to report the hazard ratio for diagnosis of depression up to 1.5 years post-stroke vs. MI, and independent predictors of PSD, and controlled for patient demographics, comorbidities, length of stay and acute stroke interventions.Results:In fully adjusted models, stroke patients (n=174,901) were ∼50% more likely than MI patients (n=193,418) to develop depression during the 1.5-year follow-up period (Kaplan-Meier cumulative risk 0.1596±0.001 in stroke patients versus 0.0973±0.000778 in MI patients, log-rank p<0.0001). History of anxiety was the strongest predictor of PSD, while discharge home was most protective. Female patients, White patients, and patients younger than 75 years were more likely to be diagnosed with depression post-stroke.Conclusions:Despite the similarities between MI and stroke, patients who suffer from stroke were significantly more likely to develop depression. There were several predictors of post-stroke depression, most significantly history of anxiety. Our findings lend credibility to a stroke-specific process causing depression and highlight the need for consistent depression screening in all stroke patients.

Abstract 22: Risk and Predictors of Depression Following Acute Ischemic Stroke in the Elderly: Comparison With Acute Myocardial Infarction

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Naomi Mayman ◽  
Laura K Stein ◽  
Stanley Tuhrim ◽  
Nathalie Jette ◽  
Mandip S Dhamoon
Keyword(s):  
Myocardial Infarction ◽  
Cox Regression ◽  
Cumulative Risk ◽  
The Elderly ◽  
Stroke Patients ◽  
Vascular Events ◽  
Post Stroke ◽  
Kaplan Meier ◽  
Post Stroke Depression ◽  
History Of

Introduction: Post-stroke depression (PSD) occurs commonly following stroke and is associated with worse outcomes and higher mortality. Previous research has not identified consistent predictors of PSD, and debate remains about whether PSD differs from other types of depression, including depression following other ischemic vascular events. Objective: We sought to comprehensively evaluate predictors of PSD in the US population and compare the hazard of developing PSD to post-myocardial infarction (MI) depression. Methods: Retrospective cohort study of 100% de-identified inpatient, outpatient, and subacute nursing Medicare data from 2016-2017 for US patients aged ≥65 years from July 1, 2016 to December 31, 2017. We calculated Kaplan-Meier unadjusted cumulative risk of depression up to 1.5 years following index admission. We performed Cox regression to report the hazard ratio for diagnosis of depression up to 1.5 years post-stroke vs. MI, as well as independent predictors of PSD, and controlled for patient demographics, comorbidities, length of stay and acute stroke interventions. Results: In fully adjusted models, stroke patients (n=174,901) were approximately 50% more likely than MI patients (n=193,418) to develop depression during the 1.5-year follow-up period (Kaplan-Meier cumulative risk 0.1596 ± 0.001 in stroke patients versus 0.0973 ± 0.000778 in MI patients, log-rank p<0.0001). History of anxiety was the strongest predictor of PSD, while discharge home was most protective. Female patients, White patients, and patients younger than 75 years were more likely to be diagnosed with depression post-stroke. Conclusions: Despite the similarities between MI and stroke, patients who suffer from stroke were significantly more likely to develop depression. There were several predictors of post-stroke depression, most significantly history of anxiety. Our findings lend credibility to a stroke-specific process causing depression and highlight the need for consistent depression screening in all stroke patients.

Serotonergic Regulation and Cognition after Stroke: The Role of Antidepressant Treatment and Genetic Variation

2019 ◽  
Vol 47 (1-2) ◽  
pp. 72-79 ◽  
Author(s):  
Andreas Gammelgaard Damsbo ◽  
Kristian Lundsgaard Kraglund ◽  
Henriette Nørmølle Buttenschøn ◽  
Søren Paaske Johnsen ◽  
Grethe Andersen ◽  
...  
Keyword(s):  
Gene Expression ◽  
Cognitive Function ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Antidepressant Treatment ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Post Stroke ◽  
Functional Polymorphisms ◽  
Brain Functions ◽  
Significant Difference

Introduction: Serotonin affects several brain functions including cognition. The serotonin transporter (SERT) regulates brain serotonin levels through reuptake into neurons. The gene encoding this transporter, the SERT gene, has several functional polymorphisms affecting the number of transporters and thereby the serotonin levels. SERT gene expression may be important for cognition and selective serotonin reuptake inhibitors (SSRI) may improve cognition post stroke. We therefore examined the association between SERT genotypes, cognitive function and early treatment with the SSRI citalopram among non-depressed Caucasian stroke patients. Patients and Methods: SERT gene polymorphisms in 270 non-depressed first-ever acute ischemic stroke patients randomized to citalopram, n = 130, or placebo, n = 140, were investigated. Patients were genotyped for a length polymorphism (L = long and S = short allele) and a single nucleotide polymorphism (A/G substitution) dividing the L-allele into LA and LG. According to these genotypes, patients were further grouped according to low (S/S, LG/S and LG/LG), medium (S/LA and LG/LA), or high functional gene expression (LALA). Cognition was measured by the Symbol Digit Modalities Test (SDMT) at 1 and 6 months. Mean SDMT scores according to genotype and randomization groups were compared using multiple logistic regression adjusting for age, stroke severity, premorbid functional status, and vascular risk factors including smoking, hypertension, and diabetes. Results: Stratified by genotype groups, there were no statistically significant differences in SDMT scores between randomization groups. Placebo-treated patients with low SERT expression genotypes, however, tended to have lower mean SDMT scores (at 1 month: 30.2, SD 10.8) compared to citalopram-treated patients (33.6, SD 13.7). Within the placebo group, the low genotype expression patients had significantly lower adjusted mean SDMT scores at 1 month compared to the high genotype expression patients (adjusted mean difference of –6 points, CI –12.0 to –0.05). We found similar results at 6 months, although not statistically significant. The genotype expression was not associated with SDMT scores among citalopram-treated patients. Conclusion: There was no difference in cognition between citalopram and placebo-treated patients according to the genotype group. Our results indicate, however, that low expression SERT genotype may contribute to reduced cognitive function post stroke as placebo-treated patients with low SERT expression tended to score lower on the SDMT. The significant difference in SDMT scores between low and high expression patients was present only in the placebo-treated group, thereby warranting further exploration of the potential effect of early citalopram treatment on cognitive functioning. Our results are preliminary and need replication in larger-scale studies.

Red Blood Cell Indices in Relation to Post-stroke Psychiatric Disorders: A Longitudinal Study in a Follow-up Stroke Clinic

2020 ◽  
Vol 17 (3) ◽  
pp. 218-223
Author(s):  
Haichao Wang ◽  
Li Gong ◽  
Xiaomei Xia ◽  
Qiong Dong ◽  
Aiping Jin ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Ischemic Stroke ◽  
Blood Cell ◽  
Cox Regression ◽  
Depression And Anxiety ◽  
Cox Regression Analysis ◽  
Post Stroke ◽  
Rbc Indices ◽  
Post Stroke Depression

Background: Depression and anxiety after stroke are common conditions that are likely to be neglected. Abnormal red blood cell (RBC) indices may be associated with neuropsychiatric disorders. However, the association of RBC indices with post-stroke depression (PSD) and poststroke anxiety (PSA) has not been sufficiently investigated. Methods: We aimed to investigate the trajectory of post-stroke depression and anxiety in our follow- up stroke clinic at 1, 3, and 6 months, and the association of RBC indices with these. One hundred and sixty-two patients with a new diagnosis of ischemic stroke were followed up at 1, 3, and 6 months, and underwent Patient Health Questionnaire-9 (PHQ-9) and the general anxiety disorder 7-item (GAD-7) questionnaire for evaluation of depression and anxiety, respectively. First, we used Kaplan-Meier analysis to investigate the accumulated incidences of post-stroke depression and post-stroke anxiety. Next, to explore the association of RBC indices with psychiatric disorders after an ischemic stroke attack, we adjusted for demographic and vascular risk factors using multivariate Cox regression analysis. Results: Of the 162 patients with new-onset of ischemic stroke, we found the accumulated incidence rates of PSD (1.2%, 17.9%, and 35.8%) and PSA (1.2%, 13.6%, and 15.4%) at 1, 3, and 6 months, respectively. The incident PSD and PSA increased 3 months after a stroke attack. Multivariate Cox regression analysis indicated independent positive associations between PSD risk and higher mean corpuscular volume (MCV) (OR=1.42, 95% CI=1.16-1.76), older age (OR=2.63, 95% CI=1.16-5.93), and a negative relationship between male sex (OR=0.95, 95% CI=0.91-0.99) and PSA. Conclusion: The risks of PSD and PSA increased substantially 3 months beyond stroke onset. Of the RBC indices, higher MCV, showed an independent positive association with PSD.

Post-Stroke Depression, Antidepressant Treatment and Rehabilitation Results

2001 ◽  
Vol 12 (3) ◽  
pp. 264-271 ◽  
Author(s):  
Stefano Paolucci ◽  
Gabriella Antonucci ◽  
Maria Grazia Grasso ◽  
Daniela Morelli ◽  
Elio Troisi ◽  
...  
Keyword(s):  
Antidepressant Treatment ◽  
Post Stroke ◽  
Post Stroke Depression

scholarly journals Association of Depression and Anxiety With Cognitive Impairment 6 Months After Stroke

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000011748
Author(s):  
Owen A Williams ◽  
Nele Demeyere
Keyword(s):  
Cognitive Impairment ◽  
Acute Stroke ◽  
Spatial Attention ◽  
Anxiety Symptoms ◽  
Cognitive Domain ◽  
Stroke Severity ◽  
Depression And Anxiety ◽  
Post Stroke ◽  
Domain Specific ◽  
Post Stroke Depression

Objective:Investigate the associations between general cognitive impairment and domain specific cognitive impairment with post-stroke depression and anxiety at six-months post-stroke.Methods:Participants were confirmed acute stroke patients from the OCS-CARE study who were recruited on stroke wards in a multi-site study and followed up at a 6 months post-stroke assessment. Depression and anxiety symptoms were assessed by the Hospital Anxiety and Depression Scale sub-scales, with scores greater than seven indicating possible mood disorders. General cognitive impairment at follow-up was assessed using the Montreal Cognitive Assessment, stroke-specific cognitive domain impairments was assessed using the Oxford Cognitive Screen. Linear regression was used to examine the associations between cognition and depression/anxiety symptoms at 6-months, controlling for acute-stroke severity and ADL-impairment, age, sex, education, and co-occurring post-stroke depression/anxiety.Results:437 participants mean age=69.28 years (S.D.=12.17), 226 male (51.72%), were included in analyses. Six-month post-stroke depression (n=115, 26%) was associated with six-month impairment on the MoCA (beta [b] =0.96, standard error [SE] =0.31, p=0.006), and all individual domains assessed by the OCS: spatial attention (b=0.67, SE=0.33, p =0.041), executive function (b=1.37, SE=0.47, p=0.004), language processing (b=0.87, SE=0.38, p=0.028), memory (b=0.76, SE=0.37, p=0.040), number processing (b=1.13, SE=0.40, p=0.005), praxis (b=1.16, SE =0.49, p=0.028). Post-stroke anxiety (n=133, 30%) was associated with impairment on the MoCA (b=1.47, SE=0.42, p=0.001), and spatial attention (b=1.25, SE=0.45, p=0.006), these associations did not remain significant after controlling for co-occurring post-stroke depression.Conclusion:Domain-general and domain-specific post-stroke cognitive impairment was found to be highly related to depressive symptomatology but not anxiety symptomatology.

Benefits of antidepressant treatment after a stroke

2017 ◽  
Vol 41 (S1) ◽  
pp. S315-S315 ◽  
Author(s):  
O. Zerriaa ◽  
O. Moula ◽  
S. Ben Saadi ◽  
I. Jelalia ◽  
R. Ghachem
Keyword(s):  
Functional Recovery ◽  
Cognitive Skills ◽  
Antidepressant Treatment ◽  
Antidepressant Drugs ◽  
Antidepressant Therapy ◽  
Motor Deficit ◽  
Stroke Patients ◽  
Double Blind ◽  
Post Stroke ◽  
Post Stroke Depression

IntroductionStroke is an important cause of morbidity and is responsible for 9% of all deaths worldwide. The most frequent neuropsychiatric consequence of stroke is post-stroke depression (PSD). It has been shown to be associated with both impaired recovery and increased mortality. The aim of our study is to determine the benefits of antidepressant prescription after a stroke.MethodThe databases from Medline and PubMed were reviewed for articles related to post-stroke depression (PSD), antidepressant treatment and stroke, post-stroke depression and functional recovery, stroke related impairment.ResultsAntidepressant drugs have been shown to be effective in treating PSD in six double blind randomized studies. Patients treated with antidepressants had better recovery from disability than patients who did not receive antidepressant therapy: it was proved that antidepressant drugs cause an improvement in cognitive skills and functional recovery in PSD patients. In patients with ischemic stroke and moderate to severe motor deficit, the early prescription of fluoxetine with physiotherapy enhanced motor recovery after 3 months. Some studies showed that PSD can be effectively prevented: nortriptyline, fluoxetine, milnacipran and sertraline appeared to be efficacious in preventing depression after stroke and are to use without significant adverse effects in stroke patients.ConclusionAntidepressant treatment plays an increasing role in the management of patients with acute stroke. Therefore, early initiation of antidepressant therapy, in non-depressed stroke patients, may reduce the odds for development of PSD, and improve cognitive and functional recovery.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Discontinuation Rates of Antidepressant Use by Dutch Soldiers

2019 ◽  
Vol 184 (11-12) ◽  
pp. 868-874
Author(s):  
Debbie G A Janssen ◽  
Eric Vermetten ◽  
Toine C G Egberts ◽  
Eibert R Heerdink
Keyword(s):  
General Practitioner ◽  
Cox Regression ◽  
Antidepressant Treatment ◽  
Discontinuation Rate ◽  
Similar Extent ◽  
Early Discontinuation ◽  
Kaplan Meier ◽  
Antidepressant Use ◽  
The Military ◽  
Over Time

Abstract Introduction Soldiers have a higher risk for developing psychiatric disorders that require treatment; often with antidepressants. However, antidepressants as well as the psychiatric disorder, may influence military readiness in several ways. In the general population, early discontinuation of antidepressant treatment is often seen. It is yet unknown whether this occurs to a similar extent in soldiers. The objective of this study was to evaluate discontinuation of antidepressant use by Dutch soldiers in the first 12 months after start and determinants thereof. Materials and Methods Data were obtained from the military pharmacy. All Dutch soldiers who started using an antidepressant between 2000 and 2014 were included. Kaplan–Meier curves were constructed to estimate the discontinuation rate over time and the influence of each determinant on discontinuation rate was estimated using Cox regression. Results About 25.9% of de 2479 starters had discontinued their antidepressant use after 1 month; after 3 and 6 months this number increased to 52.7% and 70.3%, respectively. Early discontinuation was higher in soldiers who received their first prescription from a neurologist or rehabilitation specialist (HR 1.85, 95% CI 1.55–2.21, HR 2.66 95% CI 1.97–3.58) compared to soldiers with a first prescription from a general practitioner. In addition, early discontinuation was lower in soldiers who were prescribed serotonin reuptake inhibitors and other antidepressants (HR 0.57, 95% CI 0.51–0.60, HR 0.63, 95% CI 0.55–0.73) and in soldiers between 40 and 50 years of age (HR 0.79, 95% CI 0.70–0.89). Conclusion More than half of the soldiers discontinued their prescribed antidepressant within 3 months and after 6 months, only 30% were still on antidepressants.

scholarly journals Urinary incontinence in the prediction of falls in hospitalized elderly

2014 ◽  
Vol 48 (5) ◽  
pp. 851-856 ◽  
Author(s):  
Hellen Cristina de Almeida Abreu ◽  
Annelita Almeida Oliveira Reiners ◽  
Rosemeiry Capriata de Souza Azevedo ◽  
Ageo Mário Cândido da Silva ◽  
Débora Regina de Oliveira Moura Abreu
Keyword(s):  
Urinary Incontinence ◽  
Cox Regression ◽  
Strong Predictor ◽  
Incidence Density ◽  
Hospitalized Elderly ◽  
Kaplan Meier ◽  
Exposure Variable ◽  
Elderly Inpatients ◽  
Risk Of Falls ◽  
Hospitalized Elderly Patients

Objective Analyzing the effect of urinary incontinence as a predictor of the incidence of falls among hospitalized elderly. Method Concurrent cohort study where 221 elderly inpatients were followed from the date of admission until discharge, death or fall. The Kaplan-Meier methods, the incidence density and the Cox regression model were used for the survival analysis and the assessment of the association between the exposure variable and the other variables. Results Urinary incontinence was a strong predictor of falls in the surveyed elderly, and was associated with shorter time until the occurrence of event. Urinary incontinence, concomitant with gait and balance dysfunction and use of antipsychotics was associated with falls. Conclusion Measures to prevent the risk of falls specific to hospitalized elderly patients who have urinary incontinence are necessary.



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