Antidepressant treatment reduces poststroke mortality
The Journal of Family Practice. 2004 February;53(2):93-105
February 1, 2004|The Journal of Family Practice
Author and Disclosure Information
- BACKGROUND: Depression commonly occurs after an acute stroke and is associated with an increased risk of poststroke mortality. It is uncertain to what extent antidepressant treatment reduces this risk.
- POPULATION STUDIED: This study enrolled 104 patients between the ages of 26 to 89 years (mean, 69 years) with an acute stroke within the previous 6 months. Patients were excluded if they had any other significant medical illness that would threaten survival or recovery from a stroke, severe comprehension deficit that precluded a verbal interview, history of head injury, or history of brain injury or disease other than a prior stroke.
- STUDY DESIGN AND VALIDITY: Patients were randomly assigned (uncertain allocation concealment) to receive fluoxetine, nortriptyline, or placebo unless specific contraindications were present. Fluoxetine was contraindicated for patients with an intracerebral hemorrhage; nortriptyline was contraindicated for patients with a cardiac conduction abnormality or a myocardial infarction within 3 months of the study.
- OUTCOMES MEASURED: The primary outcome measured was all-cause mortality.
- RESULTS: Baseline differences between the groups were minimal: significantly more men were assigned to the fluoxetine group and more women and patients with hemorrhagic stroke assigned to the nortriptyline group.
PRACTICE RECOMMENDATIONS
Treatment with either fluoxetine or nortripty-line for 12 weeks during the first 6 months poststroke reduced the mortality risk of both depressed and nondepressed patients. Strong consideration should be given to treating clinically depressed and nondepressed post-stroke patients who are at significant risk of developing depression (family history or personal history of mood disorders) with antidepressant medication.
