Clinical depression is associated with impaired recovery from stroke.
OBJECTIVE
To examine the effect of clinical depression on recovery from stroke.


METHODS
We examined a cohort of inpatients with stroke initially at two months after their stroke and again 14 months later. Patients were included if they: (i) provided informed consent; (ii) were able to understand the interview questions; and (iii) survived to follow-up without suffering another stroke or major medical illness. Of 61 consecutive patients, 49 met these criteria. Depression was diagnosed using a structured clinical interview. Three aspects of recovery were measured: (i) functional status; (ii) activities of daily living; and (iii) cognitive performance.


RESULTS
Twenty (41%) of the 49 patients were depressed at initial assessment. There were no significant differences in demographic, clinical, stroke or lesion characteristics between the depressed and non-depressed patients. At follow-up, depressed patients improved less than non-depressed patients in functional status (mean change from baseline, 23% versus 48%) (P = 0.001) and cognitive performance (-1% versus 11%) (P = 0.096). Mean recovery in activities of daily living was not different between the two groups (33% versus 32%) but more of the depressed patients deteriorated over time (20% versus 0%) (P = 0.047).


CONCLUSIONS
Clinical depression occurring soon after stroke is associated with impaired recovery when patients are assessed 14 months later. Depression has a negative effect on recovery in functional status and cognitive performance and may produce deterioration in physical capacity in a number of patients. Physicians would be well advised to be alert for depression and intervene early. Effective treatment of depression may enhance stroke rehabilitation.
Morris
P L
PL
Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore 21228.
Raphael
B
B
Robinson
R G
RG
D000203:Activities of Daily Living; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D002561:Cerebrovascular Disorders / Q000523:psychology / Q000534:rehabilitation*; D003071:Cognition; D015331:Cohort Studies; D003863:Depression / Q000175:diagnosis / Q000523:psychology*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011581:Psychological Tests; D013997:Time Factors
D000928:Antidepressive Agents