Depression and the Use of Selective Serotonin Reuptake Inhibitors in Patients with Acute Intracerebral Hemorrhage

Syed, Maryam Jamil; Farooq, Salman; Siddiqui, Salimuzzaman; Awan, Safia; Wasay, Mohammad

doi:10.7759/cureus.5975

Cited by 4 publications

(4 citation statements)

References 29 publications

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“…A retrospective study from a tertiary hospital in Pakistan revealed that only 2% of ICH survivors with depression were seen by a psychiatrist and only 12% received selective serotonin reuptake inhibitors (SSRIs). 50 Similarly, in a multicenter cohort from the United States, less than 10% of ICH patients received antidepressants. 48 While exposure to SSRIs was associated with resolution of post-ICH depression in a longitudinal cohort of ICH patients, there was also increased risk of recurrent hemorrhage.…”

Section: Moodmentioning

confidence: 99%

Outcome Trajectories after Intracerebral Hemorrhage

Carhuapoma,

Murthy,

Shah

2024

Semin Neurol

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Spontaneous intracerebral hemorrhage (ICH) is the most morbid of all stroke types with a high early mortality and significant early disability burden. Traditionally, outcome assessments after ICH have mirrored those of acute ischemic stroke, with 3 months post-ICH being considered a standard time point in most clinical trials, observational studies, and clinical practice. At this time point, the majority of ICH survivors remain with moderate to severe functional disability. However, emerging data suggest that recovery after ICH occurs over a more protracted course and requires longer periods of follow-up, with more than 40% of ICH survivors with initial severe disability improving to partial or complete functional independence over 1 year. Multiple other domains of recovery impact ICH survivors including cognition, mood, and health-related quality of life, all of which remain under studied in ICH. To further complicate the picture, the most important driver of mortality after ICH is early withdrawal of life-sustaining therapies, before initiation of treatment and evaluating effects of prolonged supportive care, influenced by early pessimistic prognostication based on baseline severity factors and prognostication biases. Thus, our understanding of the true natural history of ICH recovery remains limited. This review summarizes the existing literature on outcome trajectories in functional and nonfunctional domains, describes limitations in current prognostication practices, and highlights areas of uncertainty that warrant further research.

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Section: Moodmentioning

confidence: 99%

Outcome Trajectories after Intracerebral Hemorrhage

Carhuapoma,

Murthy,

Shah

2024

Semin Neurol

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“…Many ICH patients experience the lowering of motivation as an aftereffect, and this secondary depression-like symptom often impairs the course of recovery. Depression follows cerebral ischemia in approximately one-third of patients [ 1 ]; however, there is little literature about this depression.…”

Section: Introductionmentioning

confidence: 99%

Indoleamine 2, 3-dioxygenase is responsible for low stress tolerance after intracerebral hemorrhage

et al. 2023

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In the chronic phase after intracerebral hemorrhage (ICH), the aftereffect-associated lowering of motivation burdens many patients; however, the pathogenic mechanism is unclear. Here, we revealed for the first time that indoleamine 2, 3-dioxygenase (IDO) expression and enzyme activity are increased in the collagenase-induced murine ICH model. IDO is a rate-limiting enzyme situated at the beginning of the kynurenine pathway and converts tryptophan, a source of serotonin (5-hydroxytryptamine; 5-HT), to kynurenine. In this study, we showed that IDO is localized in 5-HTergic neurons. After ICH, the synaptosomal 5-HT level decreased, but this effect was neutralized by subcutaneous injections of 1-methyl tryptophan (MT), a specific IDO inhibitor. These results suggest that ICH-induced IDO weakens the activity of 5-HTergic neurons. Accordingly, we next investigated whether the IDO increase contributes to the depression-like behaviors of ICH mice. The immobility times of tail suspension and forced swimming tests were significantly prolonged after ICH but shortened by the administration of 1-MT. In conclusion, the increased IDO after ICH was found to decrease 5-HT levels and subsequently reduce stress tolerance. These findings indicate that IDO is a novel therapeutic target for the ICH aftereffect-associated lowering of motivation.

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“…A stroke may increase the risk of a variety of psychiatric disorders, such as depression, anxiety disorder, psychosis, and obsessive-compulsive disorder [ 4 , 5 , 6 , 7 , 8 ]. Depression after a stroke is a severe complication, with a reported incidence ranging from 20% to 43% at different follow-up periods [ 9 , 10 , 11 , 12 , 13 ]. Post-stroke depression (PSD) is continuously underdiagnosed and undertreated, despite its high prevalence [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Predictors of Post-Stroke Depression: A Retrospective Cohort Study

et al. 2022

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Despite reports of a high incidence and various predictors of post-stroke depression (PSD), the underdiagnosis and undertreatment rates of PSD are still high. This study aimed to examine the incidence of depression in stroke patients and identify factors associated with PSD. This was a retrospective cohort study on ischemic stroke patients from the Geisinger Neuroscience Ischemic Stroke (GNSIS) registry. The following statistical analyses were performed to predict PSD in the studied population: a Kaplan–Meier estimator and a Cox proportional hazards model. A total of 5882 patients were included in the study. The median age at the time of an ischemic stroke was 72 years and 56% were males. A total of 294 patients were diagnosed with PSD within one year of a stroke. The cumulative incidence of depression was found to be 6.4% (95% CI 5.7–7.1%) at one year for the entire cohort. Women were found to have a higher risk of PSD than men (HR for women = 1.47, 95% CI 1.18–1.85, p = 0.001). A history of prior stroke (HR = 1.58, 95% CI 1.18–2.11, p = 0.002) and myocardial infarction (HR = 1.47, 95% CI 1.05–2.06, p = 0.025) were associated with PSD. Medicaid patients had a higher risk for PSD (HR = 2.16, 95% CI 1.5–3.12, p < 0.001) than those with commercial insurance or health maintenance organization plans. Our findings showed that women, patients with a history of prior stroke or myocardial infarction, and with Medicaid insurance were more likely to develop PSD. Through an observational study on the EHR data, we confirmed that chronic stress, including financial and health-related stress, irrespective of age, significantly increased the risk for PSD.

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Depression and the Use of Selective Serotonin Reuptake Inhibitors in Patients with Acute Intracerebral Hemorrhage

Abstract: Open Access Original Article

Cited by 4 publications

References 29 publications

Outcome Trajectories after Intracerebral Hemorrhage

Outcome Trajectories after Intracerebral Hemorrhage

Indoleamine 2, 3-dioxygenase is responsible for low stress tolerance after intracerebral hemorrhage

Predictors of Post-Stroke Depression: A Retrospective Cohort Study

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