Antidepressants May Improve Multiple Outcomes after Stroke

By Splete, Heidi | Clinical Psychiatry News, June 2007 | Go to article overview

Antidepressants May Improve Multiple Outcomes after Stroke


Splete, Heidi, Clinical Psychiatry News


WASHINGTON -- Prompt, short-term treatment with antidepressants is associated with significantly improved physical, cognitive, and survival outcomes in stroke patients--regardless of whether they have symptoms of depression, Dr. Robert Robinson said at the annual meeting of the American Academy of Clinical Psychiatrists.

"Perhaps all patients who suffer a stroke should be evaluated by a psychiatrist and treated with antidepressants, because [these drugs] appear to improve their recovery," said Dr. Robinson, who serves on the speakers' bureau for Forest Laboratories Inc. He also serves as a consultant for Hamilton Pharmaceuticals Inc. and Avanir Pharmaceuticals.

Data from recent studies have shown that antidepressants have beneficial effects on physical and cognitive recovery (as well as on mortality) after a stroke and that these effects may last for several years, said Dr. Robinson, professor and head of the department of psychiatry at the University of Iowa, Iowa City.

Dr. Robinson shared data that he collected in collaboration with his colleague at the university, Dr. Kenji Narushima, on 34 stroke patients who were treated with nortriptyline, fluoxetine, or a placebo starting within a month of having a stroke (average of 19 days after the stroke) and 28 patients who began treatment more than a month after the stroke (J. Nerv. Ment. Dis. 2003;191:645-52).

The nortriptyline doses were 25 mg/day for the first week, which then was increased to 50 mg/day for weeks 2-3, 75 mg/day for weeks 4-6, and 100 mg/day for the final 6 weeks.

The fluoxetine dosage started at 10 mg/day for the first 3 weeks, which then was increased to 20 mg/day for weeks 4-6, 30 mg/day for weeks 7-9, and 40 mg/day for the final 3 weeks, the investigators reported.

The patients who were treated early had a significantly better recovery in activities of daily living than did those who were treated later, even after a logistic regression analysis controlled for several factors, including existing depression, motor impairment, and psychiatric history. The finding suggests that patients who are given antidepressants--whether they are depressed or not--within the first month after a stroke recover better than if they are given antidepressants at a later date, Dr. …

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