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Updated: Mar 9, 2026

A Middle Cerebral Artery Occlusion Technique for Inducing Post-stroke Depression in Rats
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Prevention of Poststroke Mortality Using Problem-Solving Therapy or Escitalopram.

Robert G Robinson1, Ricardo E Jorge2, Jeffrey Long3

  • 1Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA.

The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry
|December 29, 2016
PubMed
Summary

Problem-solving therapy (PST) significantly increased survival time in stroke patients. This psychological treatment, administered for one year, was associated with longer survival, unlike escitalopram or placebo.

Keywords:
Mortalityantidepressantspost-stroke depressionstroke

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Area of Science:

  • Neuroscience
  • Psychiatry
  • Gerontology

Background:

  • Depression is a significant factor in post-stroke mortality.
  • Previous research indicated that discontinuing escitalopram, but not problem-solving therapy (PST), increased depression in stroke survivors.
  • Long-term survival data following stroke treatment interventions were previously limited.

Purpose of the Study:

  • To determine if treatments initiated within 3 months post-stroke predict long-term mortality over 8-10 years.
  • To investigate the long-term impact of escitalopram, PST, and placebo on survival.
  • To test the hypothesis that PST is associated with the longest time to death.

Main Methods:

  • Re-examination of patients from a 1-year randomized controlled trial (escitalopram, PST, or placebo).
  • Follow-up interviews with families and surviving patients to ascertain health status or date/cause of death.
  • Statistical analysis using the Weibull model, controlling for age, illness severity, gender, stroke severity, and depression history.

Main Results:

  • Problem-solving therapy (PST) demonstrated a significant independent effect, increasing time to mortality.
  • Older age and major depression were independently associated with decreased time to death.
  • A significant independent effect of treatment on survival was observed.

Conclusions:

  • This study provides the first evidence linking a 1-year psychological antidepressant treatment (PST) to increased survival in stroke patients.
  • Problem-solving therapy may offer long-term survival benefits for individuals recovering from stroke.
  • The findings highlight the potential of psychological interventions in mitigating post-stroke mortality.