Too Much and Too Little: Antidepressant Treatment in Stroke Survivors during the First Year

Background: Post-stroke depression (PSD) is the most frequent mental illness after stroke, affecting about 30% of stroke survivors and hampering rehabilitation outcome. While current guidelines recommend monitored antidepressant treatment (ADT) in PSD, the limited precision between the use and need of ADT in clinical practice remains underassessed and poorly understood. Methods: Depression according to DSM criteria and ADT was assessed in n = 294 stroke survivors from two German rehabilitation centers about one, six, and twelve months after stroke. At each measurement occasion, PSD and current use of ADT was assessed, leading to four subgroups: PSD (yes/no) and ADT (yes/no). Frequencies of ADT and PSD were examined and analyzed with regard to depression severity (minor/major). Intra-individual trajectories were used to assess the persistence in ADT over- and undertreatment from a longitudinal perspective. Results: After one, 6 and 12 months, 36.7%, 31.1% and 25.5% of stroke survivors fulfilled the criteria for depression. Across all measurement occasions, 53% of depressed stroke survivors did not receive ADT, while 12% of the non-depressed did. ADT between stroke survivors with major or minor depression differed at baseline but not thereafter. Between 15–40% of the depressed without ADT experienced persisting undertreatment and 25–50% the non-depressed with ADT had not fulfilled depression criteria at an earlier time point. Conclusions: Depression occurred in one in three stroke survivors. Among these, only one in two received ADT, irrespective of PSD severity after discharge. In contrast, one in eight stroke survivors without depressive disorder received ADT, about half of them in the absence of earlier PSD. In conclusion, we found evidence of both under- and overtreatment of PSD with ADT, which emphasizes the need for a more stringent implementation of current PSD guideline recommendations

Comparison of Treatment Rates of Depression After Stroke Versus Myocardial Infarction: A Systematic Review and Meta-Analysis of Observational Data

Objective: Depression after stroke and myocardial infarction (MI) is common but often assumed to be undertreated without reliable evidence being available. Thus, we aimed to determine treatment rates and investigate the application of guidelines in these conditions. Methods: Databases MEDLINE, EMBASE, PsycInfo, Web of Science, CINAHL, and Scopus were systematically searched without language restriction from inception to June 30, 2017. Prospective observational studies with consecutive recruitment reporting any antidepressant treatment in adults with depression after stroke or MI were included. Random-effects models were used to calculate pooled estimates of treatment rates. Results: Fifty-five studies reported 32 stroke cohorts (n = 8938; pooled frequency of depression = 34%, 95% confidence interval [CI] = 29%–38%) and 17 MI cohorts (n = 10,767; pooled frequency of depression = 24%, 95% CI = 20%–28%). In 29 stroke cohorts, 24% (95% CI = 20%–27%) of 2280 depressed people used antidepressant medication. In 15 MI cohorts, 14% (95% CI = 8%–19%) of 2381 depressed people used antidepressant medication indicating a lower treatment rate than in stroke. Two studies reported use of psychosocial interventions, indicating that less than 10% of participants were treated. Conclusions: Despite the high frequency of depression after stroke and MI and the existence of efficacious treatment strategies, people often remain untreated. Innovative strategies are needed to increase the use of effective antidepressive interventions in patients with cardiovascular disease

Sensitive Commercial NASBA Assay for the Detection of Respiratory Syncytial Virus in Clinical Specimen

The aim of the study was to evaluate the usability of three diagnostic procedures for the detection of respiratory syncytial virus in clinical samples. Therefore, the FDA cleared CE marked NOW® RSV ELISA, the NucliSENS® EasyQ RSV A+B NASBA, and a literature based inhouse RT-PCR protocol were compared for their relative sensitivities. Thereby, NASBA turned out to be the most sensitive method with a total number of 80 RSV positive samples out of a cohort of 251 nasopharyngeal washings from patients suffering from clinical symptoms, followed by the inhouse RT-PCR (62/251) and ELISA (52/251). Thus, NASBA may serve as a rapid and highly sensitive alternative for RSV diagnostics

Posttraumatic stress disorder and accelerated aging: PTSD and leukocyte telomere length in a sample of civilian women.

BACKGROUND: Studies in male combat veterans have suggested posttraumatic stress disorder (PTSD) is associated with shorter telomere length (TL). We examined the cross-sectional association of PTSD with TL in women exposed to traumas common in civilian life. METHODS: Data are from a substudy of the Nurses' Health Study II (N = 116). PTSD and subclinical PTSD were assessed in trauma-exposed women using diagnostic interviews. An array of health behaviors and conditions were assessed. DNA was extracted from peripheral blood leukocytes (collected 1996-1999). Telomere repeat copy number to single gene copy number (T/S) was determined by quantitative real-time PCR telomere assay. We used linear regression models to assess associations and examine whether a range of important health behaviors (e.g., cigarette smoking) and medical conditions (e.g., hypertension) previously associated with TL might explain a PTSD-TL association. We further examined whether type of trauma exposure (e.g., interpersonal violence) was associated with TL and whether trauma type might explain a PTSD-TL association. RESULTS: Relative to not having PTSD, women with a PTSD diagnosis had shorter log-transformed TL (β = -.112, 95% confidence interval (CI) = -0.196, -0.028). Adjustment for health behaviors and medical conditions did not attenuate this association. Trauma type was not associated with TL and did not account for the association of PTSD with TL. CONCLUSIONS: Our results add to growing evidence that PTSD may be associated with more rapid cellular aging as measured by telomere erosion. Moreover, the association could not be explained by health behaviors and medical conditions assessed in this study, nor by type of trauma exposure

Genetic variants associated with subjective well-being, depressive symptoms, and neuroticism identified through genome-wide analyses

Very few genetic variants have been associated with depression and neuroticism, likely because of limitations on sample size in previous studies. Subjective well-being, a phenotype that is genetically correlated with both of these traits, has not yet been studied with genome-wide data. We conducted genome-wide association studies of three phenotypes: subjective well-being (n = 298,420), depressive symptoms (n = 161,460), and neuroticism (n = 170,911). We identify 3 variants associated with subjective well-being, 2 variants associated with depressive symptoms, and 11 variants associated with neuroticism, including 2 inversion polymorphisms. The two loci associated with depressive symptoms replicate in an independent depression sample. Joint analyses that exploit the high genetic correlations between the phenotypes (|ρ^| ≈ 0.8) strengthen the overall credibility of the findings and allow us to identify additional variants. Across our phenotypes, loci regulating expression in central nervous system and adrenal or pancreas tissues are strongly enriched for association.</p

Determinants of Antidepressant Treatment and Outpatient Rehabilitation Within the First Year After Stroke

This study aims to identify individual determinants of antidepressant treatment and outpatient rehabilitation after stroke. People with ischemic stroke (N = 303) recruited at 2 inpatient rehabilitation clinics were included into a prospective longitudinal study with follow-up telephone interviews 6 and 12 months later. Participants reported on their use of antidepressant medication and psychotherapy as well as physical, occupational, speech, and neuropsychological therapy. The use of antidepressants at discharge ( n = 65, 23.8%) was predicted by the severity of depressive symptoms, severity of stroke, history of depression, and use of antidepressants at admission (all p < .05, R2= .55). The number of outpatient rehabilitation services used at follow-ups was predicted by higher functional and cognitive impairment, higher education, younger age, severity of depressive symptoms, and lower self-efficacy (all p < .05; R26M = .24, R212M = .49). The relevance of identified determinants for the improvement of treatment rates after stroke is discussed.Humboldt UniversityPeer Reviewe

Return to work and depressive symptoms in young stroke survivors after six and twelve months: cross-sectional and longitudinal analyses

Volz M, Ladwig S, Werheid K. Return to work and depressive symptoms in young stroke survivors after six and twelve months: cross-sectional and longitudinal analyses. Topics in Stroke Rehabilitation . 2022:1-9.BACKGROUND: While depression after stroke is common and stroke prevalence globally increases in working age populations, the role of return-to-work (RTW) in the pathogenesis of post-stroke depression (PSD) remains unclear. This study examined if RTW is linked to PSD within the first year after ischemic stroke, independently from established risk factors.; METHOD: Stroke survivors (n =176) in their working age (<65years) recruited from two rehabilitation clinics were assessed for established risk factors: pre-stroke depression, activities of daily living, stroke severity, cognitive impairment, and social support. RTW and depressive symptoms (Geriatric Depression Scale: GDS-15) were assessed six- and twelve-months post-stroke. Multivariate regression analyses were used to assess the cross-sectional and longitudinal relationship between RTW and GDS-15, while controlling for established PSD risk factors.; RESULTS: Successful RTW was independently associated with lower GDS-15 at both measurement occasions (p <.05), next to the absence of pre-stroke depression and higher social support. Stroke severity predicted GDS-15 at twelve months. The predictive value of six-months RTW for subsequent depressive symptoms beyond the influence of established risk factors was SS=-1.73 (p =.09).; DISCUSSION: RTW was independently associated with PSD in young stroke survivors within the first-year post-stroke, and exerted a (marginally significant) effect on subsequent depression. Our study highlights the relevance of RTW for young stroke survivors' PSD, beyond the influence of established risk factors. Further assessments examining to what extent fostering RTW contributes to mental well-being after stroke might be promising for PSD prevention, next to evident beneficial economic effects

Depression ist weiblich – auch nach Schlaganfall? Geschlechtervergleich von Diagnosehäufigkeit und depressiver Symptomatik im Quer- und Längsschnitt

Ladwig S, Volz M, Werheid K. Depression ist weiblich – auch nach Schlaganfall? Geschlechtervergleich von Diagnosehäufigkeit und depressiver Symptomatik im Quer- und Längsschnitt. Zeitschrift für Neuropsychologie. 2018;29(3):141-147.Zusammenfassung. Während Frauen in der Allgemeinbevölkerung ein höheres Depressionsrisiko aufweisen als Männer, ist die Forschungslage zu Geschlechterunterschieden nach Schlaganfall heterogen. Die vorliegende Längsschnittstudie untersucht Geschlechterunterschiede in der Häufigkeit von depressiven Störungen und Symptomen nach Schlaganfall. An zwei deutschen Rehabilitationszentren wurden N = 174 Schlaganfallpatienten und -patientinnen 1 (n = 72 weiblich) rekrutiert und etablierte Risikofaktoren erfasst. Nacherhebungen fanden nach acht und 15 Monaten statt. Depressive Störungen und Symptome waren häufiger bei Frauen (48.2 %) als bei Männern (28.3 %) während der stationären Rehabilitation, jedoch nicht in den Folgeuntersuchungen. Etablierte Risikofaktoren beeinflussten geschlechtsunabhängig die Ausprägung depressiver Symptomatik. In Übereinstimmung mit aktuellen Meta-Analysen zeigten sich keine dauerhaften Geschlechterunterschiede bei Depression nach Schlaganfall. In der klinischen Praxis sollte die Affektlage von Schlaganfallpatienten geschlechtsunabhängig betrachtet werden

Too Much and Too Little: Antidepressant Treatment in Stroke Survivors during the First Year

Werheid K, Volz M, Ladwig S, Hackett M. Too Much and Too Little: Antidepressant Treatment in Stroke Survivors during the First Year. Journal of Integrative Neuroscience. 2022;21(4): 108.Background: Post-stroke depression (PSD) is the most frequent mental illness after stroke, affecting about 30% of stroke survivors and hampering rehabilitation outcome. While current guidelines recommend monitored antidepressant treatment (ADT) in PSD, the limited precision between the use and need of ADT in clinical practice remains underassessed and poorly understood. Methods: De-pression according to DSM criteria and ADT was assessed in n = 294 stroke survivors from two German rehabilitation centers about one, six, and twelve months after stroke. At each measurement occasion, PSD and current use of ADT was assessed, leading to four sub-groups: PSD (yes/no) and ADT (yes/no). Frequencies of ADT and PSD were examined and analyzed with regard to depression severity (minor/major). Intra-individual trajectories were used to assess the persistence in ADT over-and undertreatment from a longitudinal per-spective. Results: After one, 6 and 12 months, 36.7%, 31.1% and 25.5% of stroke survivors fulfilled the criteria for depression. Across all measurement occasions, 53% of depressed stroke survivors did not receive ADT, while 12% of the non-depressed did. ADT between stroke survivors with major or minor depression differed at baseline but not thereafter. Between 15???40% of the depressed without ADT experienced persisting undertreatment and 25???50% the non-depressed with ADT had not fulfilled depression criteria at an earlier time point. Conclusions: Depression occurred in one in three stroke survivors. Among these, only one in two received ADT, irrespective of PSD severity after discharge. In contrast, one in eight stroke survivors without depressive disorder received ADT, about half of them in the absence of earlier PSD. In conclusion, we found evidence of both under-and overtreatment of PSD with ADT, which emphasizes the need for a more stringent implementation of current PSD guideline recommendations