Does prestroke depression impact poststroke depression and treatment?
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.
Ried
L Douglas
LD
Malcom Randall Veterans Affairs Medical Center, Gainsville, FL, USA. Doug.Ried@swosu.edu
Jia
Huanguang
H
Cameon
Randi
R
Feng
Hua
H
Wang
Xinping
X
Tueth
Michael
M
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
D017367:Selective Serotonin Reuptake Inhibitors