title: Does prestroke depression impact poststroke depression and treatment?
abstract: OBJECTIVE
  To 1) describe the prevalence of before the stroke depression (BSD) and poststroke depression (PSD) and 2) serotonin selective reuptake inhibitor (SSRI) treatment patterns.
  
  
  METHODS
  Naturalistic, retrospective cohort design.
  
  
  METHODS
  Veterans Healthcare System.
  
  
  METHODS
  Seven hundred ninety veterans with confirmed stroke during fiscal year 2001.
  
  
  METHODS
  Diagnosis of depression and dispensing for antidepressants before and after stroke.
  
  
  RESULTS
  A depression diagnosis was noted for nearly 10% (N = 74) of veterans before their stroke and nearly 26% afterward (N = 205). Among those with a BSD diagnosis, 75.7% received a PSD diagnosis after their stroke. Only 20.9% of the veterans without a BSD diagnosis received a PSD diagnosis afterward (odds ratio [OR] = 9.5, 95% confidence interval [CI] = 5.4-16.5). Nearly 32% were dispensed a SSRI. Veterans receiving an SSRI before their stroke were more likely to receive one afterward (OR = 31.9, 95% CI: 17.4-58.4). Nearly 48% of those with a BSD diagnosis were dispensed an SSRI < or =30 days if they had a PSD diagnosis < or =30 days, but 48% without a PSD diagnosis were still dispensed an SSRI < or =30 days if they had a BSD diagnosis. Conversely, among those without a BSD diagnosis, 39.4% were dispensed an SSRI < or =30 days if they had a PSD diagnosis but only 7.2% without a PSD diagnosis in < or =30 days with no BSD diagnosis.
  
  
  CONCLUSIONS
  Patients' depression status before the stroke is a significant predictor of PSD and providers' SSRI prescribing behavior but not age. Given the deleterious effects of PSD, physicians may be tending toward prophylaxis or early treatment even before the evidence to support such treatment leads to standard practice recommendations.
authors.affiliation: Malcom Randall Veterans Affairs Medical Center, Gainsville, FL, USA. Doug.Ried@swosu.edu
authors.forename: L Douglas
authors.initials: LD
authors.lastname: Ried
authors.forename: Huanguang
authors.initials: H
authors.lastname: Jia
authors.forename: Randi
authors.initials: R
authors.lastname: Cameon
authors.forename: Hua
authors.initials: H
authors.lastname: Feng
authors.forename: Xinping
authors.initials: X
authors.lastname: Wang
authors.forename: Michael
authors.initials: M
authors.lastname: Tueth
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D006278:Medicare; D016017:Odds Ratio; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D020521:Stroke / Q000150:complications / Q000523:psychology*; D014481:United States / Q000453:epidemiology; D014728:Veterans
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors