Antidepressant treatment after a stroke appears to reduce mortality whether or not patients are clinically depressed, according to an article in the October issue of the American Journal of Psychiatry.

American researchers studied 104 patients who were randomized to nortriptyline, fluoxetine, or placebo after their strokes. Half of the patients on an antidepressant were clinically depressed at the start of the study (27 of 53 people), and 46.4 percent of patients who received placebo were depressed at baseline (13 of 28 people). Of the total of 104 patients, 23 did not complete the assignment to take an antidepressant or placebo for 12 weeks.

After the 9-year follow-up period, the researchers found that nearly 68 percent of the patients who received all 12 weeks of antidepressant treatment were alive (36 of 53 patients) compared with roughly 36 percent of patients who received 12 weeks of placebo (10 of 28 patients). Ricardo Jorge, MD, a coinvestigator, said the relatively small study must be considered preliminary, but the findings are nonetheless significant.

"The study implications are impressive because they indicate patients with stroke may benefit from prevention strategies that use antidepressants to improve recovery and also reduce mortality," Jorge said. "The findings also are important when you take into account that post-stroke depression is so frequent."

Post-stroke depression can occur during the first 2 years after a stroke. Approximately 20 percent of patients who have a stroke develop major depression, and another 20 percent survivors have less severe depressive symptoms.

Robert G. Robinson, M.D., the study's lead author, and his colleagues had previously found that many patients with post-stroke depression who receive antidepressants can improve activities of daily living such as bathing oneself or keeping a checkbook and cognitive function such as memory and the ability to solve problems. The research also showed that stroke patients with depression have a higher mortality rate than stroke patients who are not depressed, and the higher death rate has been linked to cardiovascular events.

Analysis of the causes of death revealed that patients who received antidepressants were less likely to die from cardiovascular problems than patients who did not receive antidepressants. Thirty percent of the patients, depressed or not, who received antidepressants and died within 9 years died from cardiovascular causes. In contrast, nearly 55 percent of patients who did not receive adequate antidepressant therapy and died during the same period died from cardiovascular causes.

Jorge said antidepressants may provide protective effects in several ways, both behaviorally and physiologically. For one, depressed patients may not comply with treatments. For example, a person who is depressed after a stroke and has diabetes may poorly control their diabetes by failing to eat properly and failing to take medications. However, a non-depressed person with diabetes may be more attentive to these important self-care measures.

Depression also may be associated with changes in platelet function. The research group plans to study how antidepressants may affect platelet function in patients who have had a stroke.