Poststroke depression: an 18-month follow-up.
OBJECTIVE
This prospective study was designed to examine the course, associates, and predictors of depressive symptoms during the first 18 months after stroke.


METHODS
A total of 100 patients were followed up for 18 months after stroke. Depressive symptoms were assessed at 2 weeks and 2, 6, 12, and 18 months after stroke with the Beck Depression Inventory and the Hamilton Rating Scale for Depression, and diagnoses were performed using criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised. Stroke severity was assessed with the Scandinavian Stroke Scale and cognitive functions with a comprehensive neuropsychological battery. Patients participated in a randomized clinical trial of antidepressive medication.


RESULTS
In all, 54% of patients felt at least mildly depressive at some time during the follow-up; 46% of those who were depressive during the first 2 months were also depressive at 12 and/or 18 months. Only 12% of patients were depressive for the first time at 12 or 18 months. The male sex was associated with a more negative change in depressive symptoms during the follow-up. Older age was associated with depressive symptoms during the first 2 months, stroke severity from 6 to 12 months, and the male sex at 18 months. Depressive symptoms were unrelated to the lesion location.


CONCLUSIONS
Depressive symptoms are frequent and they often have a chronic course. Depression is associated with stroke severity and functional impairment, and with the male sex at 18 months. Attention should be focused on the long-term prognosis of mood disturbances and adaptation.
Berg
Anu
A
Department of Neurology, Helsinki University Central Hospital, Finland. anu.berg@ekshp.fi
Palomäki
Heikki
H
Lehtihalmes
Matti
M
Lönnqvist
Jouko
J
Kaste
Markku
M
D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D003863:Depression / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008803:Mianserin / Q000627:therapeutic use; D008875:Middle Aged; D020521:Stroke / Q000150:complications*; D013997:Time Factors
D018687:Antidepressive Agents, Second-Generation; D008803:Mianserin