Care management of poststroke depression: a randomized, controlled trial

Area of Science:

• Neurology
• Psychiatry
• Public Health

Background:

• Poststroke depression is a common and debilitating condition following ischemic stroke.
• Existing evidence on effective treatments for poststroke depression remains inconclusive.
• Care management programs may offer a structured approach to managing poststroke depression.

Purpose of the Study:

• To evaluate the effectiveness of the Activate-Initiate-Monitor care management program for treating poststroke depression.
• To compare outcomes between the Activate-Initiate-Monitor intervention and usual care in ischemic stroke survivors.

Main Methods:

• A prospective, randomized, outcome-blinded trial involving 188 ischemic stroke survivors.
• The Activate-Initiate-Monitor intervention included patient activation, antidepressant initiation, and treatment monitoring.
• Depression response was defined as a Hamilton Depression Inventory score <8 or a ≥50% decrease from baseline at 12 weeks.

Main Results:

• The Activate-Initiate-Monitor group showed significantly higher rates of depression response (51% vs. 30%, P=0.005) and remission (39% vs. 23%, P=0.01) compared to usual care.
• These improvements were observed by 6 weeks and sustained through the 12-week assessment.
• No significant differences in serious adverse events were reported between the groups.

Conclusions:

• The Activate-Initiate-Monitor care management model demonstrates superior effectiveness over usual care for improving depression outcomes in poststroke patients.
• This structured care management approach is a viable and effective strategy for addressing poststroke depression.