Relieving post-stroke depression also restores lost mental function in many patients

July 05, 2000

DALLAS, July 7 -- Individuals who receive treatment for depression after a stroke get the added benefit of restoring mental abilities, which are often impaired by a stroke, according to a report in today's Stroke: Journal of the American Heart Association.

In the first double-blind treatment trial aimed at establishing a firm link between post-stroke depression and the impairment of certain mental abilities, researchers in the U.S. and Japan found that nearly three-fourths of patients who received anti-depressant drug treatment recovered some mental function that was lost after having a stroke. Researchers measured mental functions such as orientation, memory, language, and hand-eye coordination.

These findings confirm the presence of what researchers call a "dementia of depression," which sometimes mimics Alzheimer's disease in people who have had a stroke.

"A number of studies over the past 20 years have indicated an association between depression and mental impairment following a stroke," says Robert G. Robinson, M.D., of the department of psychiatry at the University of Iowa, where part of the research was carried out. "But this is the first to show that relieving depression can also often restore lost mental ability."

In the past, researchers speculated that some of the older anti-depressant drugs might actually interfere with a person's mental performance, Robinson said. "However, we found that 74 percent of the patients who completed the study responded favorably to this particular drug treatment," he says.

Robinson says anything that can effectively treat post-stroke depression, whether an old or new treatment, could also improve mental ability.

Researchers evaluated 47 patients with 21 randomly assigned to anti-depressant treatment and the other 26 to placebo. Over a period of six to 12 weeks, the anti-depressant group showed significantly greater improvement in both mood and mental function.

There are two main causes of mental impairment after a stroke, Robinson says. One is physical damage to the brain caused by the stroke itself; the other is post-stroke depression.

"For years it was thought that if a patient showed no improvement in mental ability after a stroke, the impairment was caused by the stroke lesion and that treating depression wouldn't help, but that clearly isn't true," Robinson says. "However, patients with post-stroke depression have cognitive impairment that is caused by both brain damage and depression, and most of these patients can be effectively treated with anti-depressants."

Because many stroke patients are in the same age group in which Alzheimer's disease is prevalent, medical professionals can't always be sure of the causes of dementia, he said.

"The symptoms of dementia due to stroke or Alzheimer's disease are similar," Robinson explains. "The difference is that, in Alzheimer's disease, the condition is progressive. But in stroke patients, the symptoms are at their worst at the time of the stroke and then tend to improve somewhat."

The situation is complicated by the fact that depression is often considered a "natural" part of a person's post-stroke condition and in many cases goes untreated.

"Our findings provide another compelling reason to evaluate all stroke patients for depression and to treat depression aggressively when it's found," Robinson says. "Families of stroke survivors need to know how important this is."
-end-
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Co-authors are Mahito Kimura, M.D., and James T. Kosier, B.S.

Media advisory: Dr. Robinson can be reached by phone at 319-356-4658 or email at robert-robinson@uiowa.edu . (Please do not publish phone numbers or email address.)

American Heart Association

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