Deans' stroke musings: Risk, Determinants, and Pharmacologic Treatment of Depression Following Acute Ischemic Stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, December 12, 2022

Risk, Determinants, and Pharmacologic Treatment of Depression Following Acute Ischemic Stroke

You do realize that the most effective way to eliminate post stroke depression and apathy is 100% recovery protocols? Your patients will be too busy counting reps and looking forward to recovery. Do you people ever think at all?

Why are you even treating depression? Leaders would prevent depression from occurring by 100% recovery protocols. Are you a leader or a mouse?

My god, are you that clueless that depression is a result of not getting to 100% recovery? Solve the primary problem and this secondary problem goes away. DO YOU NOT UNDERSTAND?

Risk, Determinants, and Pharmacologic Treatment of Depression Following Acute Ischemic Stroke

Laura K. Stein, MD, MPH https://orcid.org/0000-0002-8268-616X laura.stein@mssm.edu, Naomi Mayman, BS https://orcid.org/0000-0001-7666-3431, and Mandip S. Dhamoon, MD, DrPHView all authors and affiliations

Volume 13, Issue 1

https://doi.org/10.1177/19418744221123199

Abstract

Background and Purpose:

We assessed risk and determinants of new-onset depression in acute ischemic stroke (AIS) patients of all ages and no known history of depression. Additionally, we assessed patterns of post-stroke depression (PSD) treatment with pharmacotherapy.

Methods:

Retrospective cohort study of de-identified Marketscan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits Datasets for adults age ≥18 years admitted with AIS from July 1, 2016-July 1, 2017. We created Kaplan-Meier curves of cumulative risk of PSD up to 1.5 years following index AIS admission. We performed Cox regression to report hazard ratios for determinants of PSD up to 1.5 years following AIS. We summarized proportions treated with pharmacotherapy and identified the most commonly prescribed medications.

Results:

Of 8089 AIS patients, 1059 were diagnosed with PSD. At 1 year, cumulative risk of PSD was 13.4% (standard error .4) and 15.3% (standard error .5) at 1.5 years. History of anxiety was most strongly associated with PSD and discharge home least. Among those with PSD, 68.8% were prescribed an antidepressant and 8.4% an antipsychotic. The most commonly prescribed antidepressant was sertraline (28.5%).

Conclusions:

Among AIS patients of all ages, there is a persistently elevated cumulative risk of new diagnosis of PSD in the 1.5 years following AIS. Of the >2/3 treated with an antidepressant, sertraline was most commonly prescribed. Screening and treatment strategies for PSD require further study.