Increased
poststroke survival with
antidepressants
Poststroke
depression can occur during the first 2 years
following a stroke with a subsequent increase of
mortality for over 5 years after the stroke.
About one person in five who have a stroke
develops major depression, while another one in
five survivors have less severe depression. It
has been shown that stroke patients who are
depressed have a greater morbidity than
stroke patients without depression, and there is
a link between this higher death rate and
cardiovascular events. In view of this strong
relationship between poststroke depression and
mortality, a recent study assessed the effect of
antidepressant treatment on recovery and
mortality after a stroke over a 9 year follow up
period.
Early in the recovery period after a stroke, 104
patients were randomized to receive, in a
double-blind manner, nortriptyline, fluoxetine,
or placebo for 3 months. Demographic and
clinical measurements were noted at 3, 6, 9, 12,
18, and 24 months after the stroke. Mortality
data were obtained 9 years after initiation of
the study. The Kaplan-Meier method was used to
analyze the survival data.
During the 9-year follow-up 50 (48.1%) of the
104 patients died. Of the patients who received
antidepressant treatment, 67.9% were alive after
9 years, compared with only 35.7% of patients
who received placebo. After controlling for age,
coexisting diabetes mellitus, and chronic
relapsing depression which are factors
associated with mortality, a logistic regression
analysis revealed a significant beneficial
effect of antidepressants both in patients who
were depressed and those who were not depressed
when enrolled in the study.
Treatment with nortriptyline or fluoxetine for 3
months during the first 6 months poststroke
reduced mortality in both depressed and
non-depressed patients. This suggests that all
stroke survivors may benefit from a course of
treatment with antidepressants with an increased
rate of prolonged survival. Am
J Psychiatry 160: 1823-1829, 2003