A pilot study to describe antidepressant prescriptions dispensed to veterans after stroke.
BACKGROUND
Stroke is the third leading cause of death in the United States, following only heart disease and cancer. Approximately 500,000 strokes occur each year in the United States. Patients suffering from poststroke depression have higher rates of morbidity and mortality, slower physical recovery, and lower functional status than stroke patients without depression. Depressed stroke patients may benefit from early treatment with an antidepressant.


OBJECTIVE
The objectives of this study were to (1) describe antidepressant-dispensing patterns to veteran patients during the 6-month period before their stroke and 1-year time afterward and (2) examine the association of poststroke antidepressant treatment with mortality.


METHODS
Veteran patients (n=543) with one or more hospital discharges during FY2001 with a primary diagnosis of stroke were identified. The discharge date minus the length of stay indicated the index hospitalization date. Antidepressant prescription dispensing records were obtained from the Veterans Integrated System Network 8 Veteran's Affairs (VA) Pharmacy Benefits Management database.


RESULTS
One-third of eligible veteran patients were dispensed one or more antidepressant prescriptions (n=181) either before or after the index hospitalization. Of these veterans, 146 received an antidepressant after the index hospitalization. More than 80% of veteran patients survived the stroke for 1 year or longer (n=448). Among the veteran patients who were discharged from the index hospitalization alive, those with no antidepressant or an antidepressant dispensed only before the stroke had a higher 1 year all cause mortality rate (8.0%) compared with those who were dispensed a prescription for one or more antidepressants afterward (4.8%).


CONCLUSIONS
Veterans dispensed an antidepressant after their stroke appeared to have benefited. Opportunities to reduce poststroke sequelae and improve recovery may be lost.
Ried
L Douglas
LD
Rehabilitation Outcomes Research Center (151B), Malcom Randall Veterans Affairs Medical Center, Gainesville, FL 32608-1197, USA. doug.ried@med.va.gov
Tueth
Michael J
MJ
Jia
Huangang
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003863:Depression / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D011307:Drug Prescriptions; D004363:Drug Utilization; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010818:Practice Patterns, Physicians'; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications* / Q000401:mortality / Q000523:psychology; D016019:Survival Analysis; D013997:Time Factors; D014728:Veterans
D000928:Antidepressive Agents