Prevention of Poststroke Mortality Using Problem-Solving Therapy or Escitalopram

Am J Geriatr Psychiatry. 2017 May;25(5):512-519. doi: 10.1016/j.jagp.2016.10.001. Epub 2016 Oct 8.

Abstract

Objective: This study re-examined patients from a 1-year randomized controlled double-blind trial of escitalopram, problem-solving therapy (PST), or placebo to prevent depression among patients less than 3 months after a stroke. The objective of the current study was to determine if preventive treatment would predict time to death over 8-10 years of follow-up. Based on the importance of depression in poststoke mortality and a previous study of this population at 18 months' follow-up showing that stopping escitalopram but not PST led to a significant increase in depression, the authors hypothesized that PST would be associated with the longest time to death.

Methods: Of 129 eligible patients, 122 were contacted and 7 were lost to follow-up. Families and surviving patients were interviewed to determine current health status or the date and cause of death.

Results: Using the Weibull model of log time (years) to death, controlled for age, severity of physical illness, gender, severity of stroke, and history of depression after study entry, there was a significant independent effect of treatment. PST significantly and independently increased the time to mortality, whereas older age and major depression significantly and independently decreased the time to death.

Conclusion: To the authors' knowledge, this is the first time a psychological antidepressant treatment administered for 1 year has been associated with increased survival among patients who have suffered a stroke.

Keywords: Mortality; antidepressants; post-stroke depression; stroke.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Antidepressive Agents, Second-Generation / therapeutic use
  • Citalopram / therapeutic use*
  • Depression / complications
  • Depression / drug therapy*
  • Depression / prevention & control
  • Depression / therapy*
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Middle Aged
  • Problem Solving*
  • Psychotherapy*
  • Stroke / complications
  • Stroke / mortality*
  • Time Factors

Substances

  • Antidepressive Agents, Second-Generation
  • Citalopram