In-hospital predictors of post-stroke depression for targeted initiation of Selective Serotonin Reuptake Inhibitors (SSRIs)

Abstract

Background Although SSRIs are no longer widely prescribed for post-stroke motor recovery, fluoxetine demonstrated beneficial effects on post-stroke depression (PSD). Given the potential side effects of SSRIs, targeted initiation among individuals at highest risk for PSD warrants consideration. While previous studies have identified stroke severity and psychiatric history as factors associated with PSD, its predictability remains unknown. In this study, we investigate inpatient predictive factors to better identify individuals who might derive the most benefit from targeted initiation of SSRIs. Methods We performed a retrospective analysis of a prospectively-collected registry of adult patients presenting with acute ischemic stroke to a tertiary referral urban academic comprehensive stroke center between 2016–2020. Patients were seen 4–6 weeks post-discharge and administered the PHQ-9 (Patient Health Questionnaire-9) to screen for PSD (PHQ-9 ≥ 5). Demographics, history of depression, stroke severity, and inpatient PHQ-9 scores were abstracted. Logistic regression was used to determine factors associated with PSD and an ROC analysis determined the predictability of PSD in the inpatient setting. Results Three hundred seven individuals were administered the PHQ-9 at follow-up (mean age 65.5 years, 52% female). History of depression (OR = 4.11, 95% CI: 1.65–10.26) and inpatient PHQ-9 score (OR = 1.17, 95% CI: 1.06–1.30) were significantly associated with PSD. Stroke severity, marital status, living alone, employment, and outpatient therapy were not associated with PSD. The ROC curve using a positive inpatient PHQ-9 achieved an area under the curve (AUC) of 0.65 (95% CI: 0.60–0.70), while the AUC was 0.72 (95% CI: 0.66–0.77) after adding history of depression. Conclusions History of depression and a positive inpatient PHQ-9 appear to be most strongly predictive of long-term PSD. Initiating SSRIs only in those individuals at highest risk for PSD may help reduce the burden of stroke recovery in this targeted population while minimizing adverse side effects.

Predictive microbial feature analysis in patients with depression after acute ischemic stroke

“…In this study, gender, education level, diabetes mellitus, alcohol drinking, Barthel Index, FT3 differ significantly in PSD and non-PSD, which may be attributed to the occurrence of PSD compared with non-PSD. Many researchers have investigated a series of scoring systems from PSD prediction ( Pan et al, 2022 ; Yi et al, 2022 ). Prospective studies assessed the predictive power of HAMD score for PSD, which were commonly used in clinical ( Kang et al, 2013 ).…”

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“…5-Hydroxytryptamine (5-HT), a pivotal monoamine neurotransmitter, facilitates communication between nerve cells in both central and peripheral nervous systems. Selective serotonin reuptake inhibitors (SSRIs) have demonstrated efficacy in treating post-stroke depression (PSD) ( 120 ). The onset of PSD might be attributed to diminished neurotransmission owing to damage to the mood-regulating frontal/temporal-basal ganglia-ventral brainstem loop and interruptions in 5-HTergic neurons and pathways.…”