A stroke results when blood flow to part of the brain is interrupted, often because of a blood clot or hardened arteries. The aftereffects of a stroke can be debilitating. Stroke survivors often undergo years of intense physical and cognitive therapy, and many never completely regain their previous levels of function. This population is also at an elevated risk of developing depression. About half of all stroke survivors will develop some degree of depression in the weeks and months following their initial attack. With this information in hand, researchers have investigated various means for preventing depression in stroke survivors. Prevention is always the most desirable treatment, as this reduces both health care costs and the risk of complicating conditions or early mortality.
In a study of stroke survivors in the United States, individuals were prescribed Lexapro (escitalopram) or a placebo, or they were assigned to problem-solving therapy. Researchers were happy to conclude that both Lexapro and problem-solving therapy were effective in preventing depression, delaying its onset, or reducing its severity. No previous study had ever demonstrated prevention of a psychiatric condition in these circumstances. Furthermore, there were no significant adverse effects for those who completed the study beyond minor and expected side effects. Several people did pass away from unrelated conditions or events, most related to advanced age, disease, or accident.
Previous studies of poststroke depression have been inconclusive. This could be a result of enrolling more elderly participants or participants with more severe stroke. The Lexapro and problem-solving study team sought to achieve a representative sample of stroke survivors. Lexapro was chosen largely because of its well-established safety and effectiveness. Even at low doses, this antidepressant medication has been shown to be therapeutically useful. Because prevention and treatment are fundamentally different methodologies, an even lower starting dose than the one used in this study might deliver results. What these results mean for stroke survivors is obvious. Depression is a serious risk to health and wellbeing for people already in a delicate state or health. Therefore, all available tools that may delay o prevent the onset of depression, while producing a minimum of adverse effects, should be considered by attending physicians.
Robinson, R.G., Jorge, R.E., Moser, D.J., Acion, L., Solodkin, A., Small, S.L., Fonzetti, P. et al. (2008). Escitalopram and problem-solving therapy for prevention of poststroke depression: a randomized controlled trial. Journal of the American Medical Association, 299, (20), 2391-2400.
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