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J Stroke. 2018 May;20(2):258-267. doi: 10.5853/jos.2017.02712. Epub 2018 May 31.

Differences in Therapeutic Responses and Factors Affecting Post-Stroke Depression at a Later Stage According to Baseline Depression.

Author information

1
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
2
Department of Neurology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea.
3
Department of Neurology, Myongji Hospital, Goyang, Korea.
4
Department of Neurology, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea.
5
Department of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea.
6
Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
7
Department of Neurology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
8
Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
9
Department of Neurology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea.
10
Department of Neurology, Konkuk University School of Medicine, Seoul, Korea.
11
Department of Neurology, Kangwon National University School of Medicine, Chuncheon, Korea.
12
Department of Neurology, Korea University Asan Hospital, Korea University College of Medicine, Asan, Korea.
13
Department of Neurology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea.
14
Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
15
Department of Neurology, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea.
16
Department of Neurology, Daegu Fatima Hospital, Daegu, Korea.
17
Department of Neurology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
18
Department of Psychiatry, Hyundai Hospital, Eumseong, Korea.
19
The Research Institute of Nursing Science, Seoul National University College of Nursing, Seoul, Korea.
20
College of Medicine, Michigan State University, East Lansing, MI, USA.
21
Clinical Research Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Abstract

BACKGROUND AND PURPOSE:

The pathophysiology of post-stroke depression (PSD) is complex and may differ according to an individual's mood immediately after stroke. Here, we compared the therapeutic response and clinical characteristics of PSD at a later stage between patients with and without depression immediately after stroke.

METHODS:

This study involved a post hoc analysis of data from EMOTION (ClinicalTrials.gov NCT01278498), a placebo-controlled, double-blind trial that examined the efficacy of escitalopram (10 mg/day) on PSD and other emotional disturbances among 478 patients with acute stroke. Participants were classified into the Baseline-Blue (patients with baseline depression at the time of randomization, defined per the Montgomery-Asberg Depression Rating Scale [MADRS] ≥8) or the Baseline-Pink groups (patients without baseline depression). We compared the efficacy of escitalopram and predictors of 3-month PSD (MADRS ≥8) between these groups.

RESULTS:

There were 203 Baseline-Pink and 275 Baseline-Blue patients. The efficacy of escitalopram in reducing PSD risk was more pronounced in the Baseline-Pink than in the Baseline-Blue group (p for interaction=0.058). Several risk factors differentially affected PSD development based on the presence of baseline depression (p for interaction <0.10). Cognitive dysfunction was an independent predictor of PSD in the Baseline-Blue, but not in the Baseline-Pink group, whereas the non-use of escitalopram and being female were more strongly associated with PSD in the Baseline-Pink group.

CONCLUSIONS:

Responses to escitalopram and predictors of PSD 3 months following stroke differed based on the presence of baseline depression. Our data suggest that PSD pathophysiology is heterogeneous; therefore, different therapeutic strategies may be needed to prevent PSD emergence following stroke.

KEYWORDS:

Anger; Depression; Emotional incontinence; Escitalopram; Stroke

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