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, DrPH+2View 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.

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