Brief Psychosocial–Behavioral Intervention With Antidepressant Reduces Poststroke Depression Significantly More Than Usual Care With Antidepressant

Abstract

Background and Purpose-Depression after stroke is prevalent, diminishing recovery and quality of life. Brief behavioral intervention, adjunctive to antidepressant therapy, has not been well evaluated for long-term efficacy in those with poststroke depression. Methods-One hundred one clinically depressed patients with ischemic stroke within 4 months of index stroke were randomly assigned to an 8-week brief psychosocial-behavioral intervention plus antidepressant or usual care, including antidepressant. The primary end point was reduction in depressive symptom severity at 12 months after entry. Results-Hamilton Rating Scale for Depression raw score in the intervention group was significantly lower immediately posttreatment (PϽ0.001) and at 12 months (Pϭ0.05) compared with control subjects. Remission (Hamilton Rating Scale for Depression Ͻ10) was significantly greater immediately posttreatment and at 12 months in the intervention group compared with the usual care control. The mean percent decrease (47%Ϯ26% intervention versus 32%Ϯ36% control, Pϭ0.02) and the mean absolute decrease (Ϫ9.2Ϯ5.7 intervention versus Ϫ6.2Ϯ6.4 control, Pϭ0.023) in Hamilton Rating Scale for Depression at 12 months were clinically important and statistically significant in the intervention group compared with control. Conclusion-A brief psychosocial-behavioral intervention is highly effective in reducing depression in both the short and long term.

Successful aging in community seniors and stroke survivors: current and future strategies

“…Although such efforts to boost mental health may not alter the progression of the neurologic disease, they may have a significant positive impact on the individual's quality of life as well as that of the patient's caregivers. In stroke survivors, cognitive behavioral therapy appeared to reduce negative mood and enhance well-being [49,50]. In a randomized controlled trial, stroke patients were assigned to receive brief psychosocial and behavioral intervention as well as antidepressant medication, or antidepressant medication and treatment-as-usual.…”

“…In a randomized controlled trial, stroke patients were assigned to receive brief psychosocial and behavioral intervention as well as antidepressant medication, or antidepressant medication and treatment-as-usual. The former intervention was associated with a remission in depressive symptoms that lasted at least 12 months [50]. Improving social support and training patients to effectively use coping strategies are two other approaches that may have some benefit as secondary prevention strategies in stroke [27], but are yet to be closely investigated using an interventional study design.…”

Pre-post Evaluation of Automated Reminders May Improve Detection and Management of Post-stroke Depression

“…Although effective treatments for PSD exist, [11][12][13][14] VA (Veterans Affairs) and non-VA studies have documented that a significant proportion of patients with PSD do not receive consistent treatment. 15,16 Even though the VA has effectively implemented annual depression screening in primary care (PC) clinics, with recent composite behavioral screening rates above 90% in all VA regions, 17 and the majority of veterans with diagnosed depression receive an antidepressant, 18,19 the duration and follow-up of antidepressant treatment is frequently inadequate.…”

Management of a post-stroke patient

“…Для профилактики постинсультной депрессии эф-фективна психотерапия [14], однако при уже развив-шейся депрессии одной психотерапии недостаточно, не-обходимо ее сочетание с приемом антидепрессанов [17]. В качестве психотерапевтических методов при постин-сультной депрессии часто используют когнитивно-пове-денческую терапию и разрешающую проблемы терапию, которые могут применяться и для профилактики де-прессии, а при ее развитии дополняют лечение антиде-прессантами [15].…”

“…Длительность лечения составляет 2-6 мес. Использование антидепрес-сантов может улучшить не только эмоциональное состо-яние, но и когнитивные функции, привести к более бы-строму и существенному регрессу неврологических нарушений, повысить качество жизни пациентов [17].…”