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Antidepressants Help Stroke Recovery

Medications Stabilize Mental, Physical, and Emotional Functions
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WebMD Health News

Oct. 1, 2003 -- Taking antidepressants after a stroke -- whether you are depressed or not -- may improve your stroke-recovery chances, and even prevent early death, a new study shows.

Depression occurs in about 40% of people who have a stroke. And being depressed makes regaining mental and physical functions during stroke recovery even more difficult, say researchers.

In fact, depressed stroke patients are much more likely to die within a few years, writes researcher Ricardo E. Jorge, MD, a psychiatrist with the University of Iowa College of Medicine. His study appears in the October issue of the American Journal of Psychiatry.

Longer Chance of Survival

In his study, Jorge and colleagues looked at whether antidepressant medications would help stroke recovery and improve long-term survival.

Among 100 patients who had a stroke within the last six months, half were treated with an antidepressant -- either Prozac or nortriptyline -- for 12 weeks regardless of whether or not they were showing signs of depression. The other half received a placebo. Neither the researchers nor the patients knew which people were taking an antidepressant or a look-alike placebo.

For two years during the patients' stroke recovery, doctors regularly evaluated each person's mental, physical, and emotional functioning -- either during visits at patients' homes or in the hospital.

Nine years after the study began, 68% of the patients who took an antidepressant were still alive compared with 36% of those who got the placebo. Both antidepressants had about the same results: 70% of those taking Prozac were still alive, compared with 65% of the nortriptyline group.

"The most striking finding was that patients who had received active antidepressant treatment were more likely to survive, compared with patients who did not receive such treatment, regardless of whether they were initially depressed," writes Jorge.

What's Happening?

During stroke recovery, depressed patients might not take their medications or take other steps to improve health, he explains. For example, people with diabetes may be less inclined to follow a healthy diet and take their medications when necessary. Doing either would significantly increase the risk for another stroke and other complications.

However, there are likely physiological changes at work, he explains. Antidepressants may reverse or correct multiple body mechanisms -- including heart rate and nervous system chemicals like serotonin, which are known to affect formation of dangerous blood clots. Most strokes are caused by blood clots in the brain.

Also, antidepressants could produce long-lasting changes in those nerve networks that control the body's response to stress.

There is evidence that antidepressants can have long-lasting effects: Of the 36 patients in the study who received antidepressants, 17 continued taking them for about another year. Nine years later, 88% were still alive, compared with 53% of those who took only the first 12-week round of antidepressants, reports Jorge.

In addition, treatment with antidepressants during early weeks of stroke recovery might prevent depression later on, he says.

SOURCE: Jorge, R. American Journal of Psychiatry. October 2003; vol 160: pp 1823-1829.

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