EPIDEMIOLOGY AND TREATMENT OF POSTSTROKE DEPRESSION

Depression is a common and serious complication after stroke, Accordin g to epidemiological studies, at least 30% of stroke patients experien ce depression, both early and late after stroke, However, in clinical practice only a minority of the patients are diagnosed and even fewer are treated. There are several studies confirming the magnitude of the problem but the main conclusion which can be drawn from the few treat ment studies published is that tricyclic antidepressants cannot be rec ommended for the treatment of poststroke depression, mainly because of the high frequency of contraindications and adverse effects. Until no w there has only been 1 double-blind, placebo-controlled treatment stu dy from which some general conclusions can be drawn. The study evaluat ed a selective serotonin reuptake inhibitor (citalopram) and concluded that the drug was well tolerated and effective for the treatment of p ost-stroke depression, However, when treatment was initiated very earl y, both the treatment group and the placebo group improved equally dur ing the first 7 weeks after stroke. This finding could indicate diagno stic difficulties during the first few weeks after stroke. A recent st udy, although small, comparing the combination of drugs with either no radrenergic (desipramine plus mianserin) or noradrenergic and serotone rgic effects (imipramine plus mianserin) for post-stroke depression, i ndicated that drugs with the dual effect may be more effective. Many m ore double-blind placebocontrolled treatment studies and studies compa ring the efficacy and adverse effects of various antidepressants in pa tients with post-stroke depression need to be conducted. According to 3 small studies, electroconvulsive therapy (ECT) seems to be quite wel l tolerated and therefore ECT may also be considered in the treatment of post-stroke depression. Future studies should also address the long term efficacy of treatment for post-stroke depression.