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Depression Experienced by One-Third of Stroke Patients, Loyola Study Shows

MAYWOOD, Ill. - About one-third of patients suffer depression following a stroke, and depression in turn increases the risk of stroke, according to a review article by Loyola University Medical Center physicians.

Antidepressant medications known as SSRIs, such as fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro), are effective when given to stroke patients as a preventive measure, the physicians write in the journal Topics in Stroke Rehabilitation.

Authors are first author Murray Flaster, MD, PhD, who specializes in stroke care, and psychiatrists Aparna Sharma, MD, and Murali Rao, MD, who specialize in depression.

Mental disorders are common after stroke. They include anxiety, irritability and agitation, uncontrollable crying, apathy, delusions and hallucinations. But the most common disorder is depression, either major or minor.

Some patients recover over time, while others move in and out of depression. For some patients, depression doesn’t develop until up to two years after the stroke.

Post-stroke depression (PSD) is linked to worse functional outcomes and increased risks of suicide and mortality.

Women are more likely to suffer PSD. Other risk factors include living alone and away from family members, higher levels of education, changes in lifestyle or marital status and degree of functional impairment. Depression, in turn, is a risk factor for stroke and stroke recurrence, even after controlling for other risk factors.

Given the severe effects of PSD, doctors should take an aggressive approach. Timing of medication may be crucial, with early treatment perhaps advantageous. In addition to helping relieve depression, antidepressants also have been shown to improve cognitive and functional recovery. Recent evidence also shows that SSRIs are helpful in motor recovery (improved movement and coordination).

“Taken together, the available data make a strong case for the prophylactic use and effectiveness of antidepressants post stoke,” the authors write.

Flaster is an associate professor in the departments of Neurology and Neurological Surgery of Loyola University Chicago Stritch School of Medicine. Sharma is an assistant professor and Rao is a professor and chair of the Department of Psychiatry and Behavioral Neurosciences.

The title of their article is “Poststroke Depression: A Review Emphasizing the Role of Prophylactic Treatment and Synergy with Treatment for Motor Recovery.”

Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and more than 30 primary and specialty care facilities in Cook, Will and DuPage counties. The medical center campus is conveniently located in Maywood, 13 miles west of the Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the medical center campus is a 559-licensed-bed hospital that houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children's Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as the LUC Stritch School of Medicine, the LUC Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb campus in Melrose Park includes the 255-licensed-bed community hospital, the Professional Office Building housing 150 private practice clinics, the Adult Day Care, the Gottlieb Center for Fitness, Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.

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