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 Researchers analyzed data on a large group of stroke patients and
compared them to similar people who didn’t have a stroke.
Within two years after a stroke, 25 percent of patients had a
diagnosis of depression, with more than half the diagnoses coming
within the first three months.
By comparison, slightly less than 8 percent of the people who didn’t
have a stroke had a depression diagnosis during the study, and less
than a quarter of these cases were found within the first three
months of the study.
“The frequency of depression in stroke patients is also much higher
as compared to patients experiencing other acute somatic events such
as a heart attack,” said senior study author Dr. Merete Osler of
Copenhagen University in Denmark.
“It seems that some imbalance in the brain induced by the stroke may
cause stroke patients to be more susceptible to depression,” Osler
added by email.
More than 30 million people worldwide live with a stroke diagnosis,
Osler and colleagues note in JAMA Psychiatry.
Depression afterward is common.
As in people who don’t have a stroke, the risk for depression
increases with age and is also greater for women, individuals who
live alone or have less education, and people with diabetes or a
history of mental health problems, the authors point out.
To see how stroke may influence the risk of depression, researchers
examined data from seven Danish nationwide registries on 157,243
people aged 15 and older hospitalized for the first time with a
stroke from 2001 to 2011, and 160,236 similar people without stroke.
Overall, more than 34,000 stroke survivors and more than 11,000
people who didn’t have a stroke were diagnosed with depression
during two years of follow-up.
Researchers also looked at how depression influenced survival.
For people without a stroke, depression was associated with nearly
three-times higher odds of death from any cause during the study
period. For stroke survivors, depression was linked to an 89 percent
greater likelihood of death during the study.
The heightened death risk was most pronounced with recent onset
depression, the study also found.
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One limitation of the study, however, is that a depression diagnosis
was often identified based on patients filling prescriptions for
antidepressants, the authors note. This might not reflect all cases
of depression or capture the severity of the condition.
Even so, the findings suggest that doctors, patients and families
need to be alert for depression and other mood disorders after a
stroke, Dr. Craig Anderson, executive director of the George
Institute for Global Health at the University of Sydney, Australia,
wrote in an accompanying editorial.
“We know that it is very common – one in three stroke survivors
suffer from some form of depression – and that it adversely impacts
on recovery and increases the risks of recurrent stroke and other
serious cardiovascular events and death,” Anderson said by email.
“We know it is difficult to diagnose because patients have problems
with speech and memory, and their physical disability, and there is
uncertainty how to best manage the condition,” Anderson added.
Often, doctors may take a watchful waiting approach for a few weeks
after depression symptoms first surface, followed by psychological
counseling or antidepressants, Anderson said.
Patients and families should speak up if they suspect a mental
health issue.
“Depression is common and it is ok to feel flat and down after a
stroke,” Anderson said. “However, sometimes this can be more serious
and require treatment.”
SOURCE: http://bit.ly/2bZwQQm JAMA Psychiatry, online September 7,
2016.
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