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Interventions for preventing depression after stroke.

C S Anderson, M L Hackett, A O House

    The Cochrane Database of Systematic Reviews
    |April 24, 2004
    PubMed
    Summary
    This summary is machine-generated.

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    Early antidepressant or psychological treatments after stroke do not prevent depression. Psychotherapy showed a small mood improvement, but more research is needed to confirm its effectiveness in stroke recovery.

    Area of Science:

    • Neurology
    • Psychiatry
    • Evidence-based Medicine

    Background:

    • Abnormal mood, including depression and anxiety, is a common consequence of stroke, impacting patient recovery and outcomes.
    • Current detection and treatment of post-stroke mood disorders are often inadequate, partly due to uncertainty about early intervention effectiveness.

    Purpose of the Study:

    • To evaluate the efficacy of pharmaceutical and psychological interventions in preventing depression and improving outcomes in stroke patients.
    • To determine if early treatment can mitigate depressive illness, abnormal mood, and enhance physical and psychological recovery post-stroke.

    Main Methods:

    • Systematic review of randomized and quasi-randomized controlled trials identified through extensive database searches (Cochrane, MEDLINE, EMBASE, etc.) up to September 2002.

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  • Included trials compared pharmaceutical agents (e.g., SSRIs) or psychotherapy against placebo or standard care in recent stroke patients, aiming to prevent depression.
  • Primary outcome was the proportion of patients meeting depression criteria; secondary outcomes included mood scores, disability, mortality, and adverse effects.

    • Main Results:

    • Twelve trials with 1245 participants were analyzed, including nine trials on pharmacological agents and three on psychotherapy.
    • Pharmacological therapy showed no clear effect on preventing depression or improving other measures.
    • Psychotherapy demonstrated a small, statistically significant improvement in mood in one trial, but no effect on diagnosed depression.

    Conclusions:

    • Psychotherapy offers a minor but significant benefit for improving mood in stroke patients, though not for preventing diagnosed depression.
    • Neither pharmacotherapy nor psychotherapy, as evaluated in this review, effectively prevents depressive illness, disability, or improves other post-stroke outcomes.
    • Further robust evidence is necessary to support recommendations for the routine use of these interventions to enhance stroke recovery.