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Published on: May 22, 2019
A one-year follow-up study into the course of depression after stroke
1Dpt. Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. a.bour@mumc.nl
Insights
Post-stroke depression (PSD) affects over a third of stroke survivors within a year. While many recover, older patients and those with major depression face higher risks of recurrence or persistent symptoms, necessitating careful monitoring and potential treatment.
Area of Science:
- Neuroscience
- Psychiatry
- Clinical Neurology
Background:
- Neuropsychiatric disorders, particularly depression, are common in stroke patients.
- These conditions significantly impact stroke outcomes and recovery.
- Current diagnostic and treatment strategies for post-stroke psychiatric disorders remain under discussion.
Purpose of the Study:
- To investigate the longitudinal course of depression following a stroke.
- To determine the incidence and prevalence of post-stroke depression (PSD).
- To identify factors associated with depression recurrence and persistence.
Main Methods:
- Prospective study involving 191 first-ever stroke patients.
- Screening for depressive symptoms at 1, 3, 6, 9, and 12 months post-stroke.
- Diagnosis of major and minor depression based on DSM-IV criteria.
Main Results:
- Cumulative incidence of PSD reached 36.2% within one year.
- Prevalence of PSD was 18.8% at one month post-stroke.
- Recurrence occurred in 44% of initially depressed patients; persistence was noted in 40% of PSD cases, particularly in older, more disabled patients with major depression.
Conclusions:
- Post-stroke depression frequently emerges within the first month.
- While recovery is common, clinicians must recognize the potential for symptom recurrence, especially in older individuals.
- Persistent or recurrent depression, particularly major depression, warrants consideration for treatment, while milder cases may benefit from observation.
Background:
Stroke patients commonly suffer from neuropsychiatric disorders, such as depression, that negatively influence stroke outcome. Diagnosis, treatment and prevention of post-stroke psychiatric disorders including depression are under debate.
Objective:
To study the course of depression after stroke.
Methods:
One hundred and ninety first-ever stroke patients were screened for depressive symptoms at 1, 3, 6, 9, and 12 months after stroke. Diagnosis of depression was made according to the DSM-IV criteria of major and minor depression.
Results:
Follow-up was completed in 138 patients. The cumulative incidence of post-stroke depression (PSD) in 1 year was 36.2%. One month after stroke the prevalence of PSD was 18.8%. Thirty percent of patients who were depressed in the first three months did not reach cut-off levels on depression screening instruments at the following assessments. In 44% of these patients symptoms recurred. Recurrent cases were older than patients with limited disease. In 40% of PSD patients depression persisted for at least two consecutive following follow-up visits. Persistent cases were more disabled and suffered more often from major depression.
Conclusion:
Half of PSD patients become depressed within the first month after stroke. Although most patients recover, a clinician has to be aware that symptoms can recur especially in older patients and that in patients with major depression symptoms may be persistent. In these patients treatment should be considered, whereas in patients with limited disease an observational approach may suffice.
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