Differences in Therapeutic Responses and Factors Affecting Post-Stroke Depression at a Later Stage According to Baseline Depression
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Background and Purpose The pathophysiology of post-stroke depression (PSD) is complex and may differ according to an individual’s mood immediately after stroke. Here, we compared the therapeutic response and clinical characteristics of PSD at a later stage between patients with and without depression immediately after stroke. Methods This study involved a post hoc analysis of data from EMOTION (ClinicalTrials.gov NCT01278498), a placebo-controlled, double-blind trial that examined the efficacy of escitalopram (10 mg/day) on PSD and other emotional disturbances among 478 patients with acute stroke. Participants were classified into the Baseline-Blue (patients with baseline depression at the time of randomization, defined per the Montgomery-Asberg Depression Rating Scale [MADRS] ≥8) or the Baseline-Pink groups (patients without baseline depression). We compared the efficacy of escitalopram and predictors of 3-month PSD (MADRS ≥8) between these groups. Results There were 203 Baseline-Pink and 275 Baseline-Blue patients. The efficacy of escitalopram in reducing PSD risk was more pronounced in the Baseline-Pink than in the Baseline-Blue group (P for interaction=0.058). Several risk factors differentially affected PSD development based on the presence of baseline depression (P for interaction <0.10). Cognitive dysfunction was an independent predictor of PSD in the Baseline-Blue, but not in the Baseline-Pink group, whereas the non-use of escitalopram and being female were more strongly associated with PSD in the Baseline-Pink group. Conclusions Responses to escitalopram and predictors of PSD 3 months following stroke differed based on the presence of baseline depression. Our data suggest that PSD pathophysiology is heterogeneous; therefore, different therapeutic strategies may be needed to prevent PSD emergence following stroke.
Abstract
Background and Purpose The pathophysiology of post-stroke depression (PSD) is complex and may differ according to an individual’s mood immediately after stroke. Here, we compared the therapeutic response and clinical characteristics of PSD at a later stage between patients with and without depression immediately after stroke. Methods This study involved a post hoc analysis of data from EMOTION (ClinicalTrials.gov NCT01278498), a placebo-controlled, double-blind trial that examined the efficacy of escitalopram (10 mg/day) on PSD and other emotional disturbances among 478 patients with acute stroke. Participants were classified into the Baseline-Blue (patients with baseline depression at the time of randomization, defined per the Montgomery-Asberg Depression Rating Scale [MADRS] ≥8) or the Baseline-Pink groups (patients without baseline depression). We compared the efficacy of escitalopram and predictors of 3-month PSD (MADRS ≥8) between these groups. Results There were 203 Baseline-Pink and 275 Baseline-Blue patients. The efficacy of escitalopram in reducing PSD risk was more pronounced in the Baseline-Pink than in the Baseline-Blue group (P for interaction=0.058). Several risk factors differentially affected PSD development based on the presence of baseline depression (P for interaction <0.10). Cognitive dysfunction was an independent predictor of PSD in the Baseline-Blue, but not in the Baseline-Pink group, whereas the non-use of escitalopram and being female were more strongly associated with PSD in the Baseline-Pink group. Conclusions Responses to escitalopram and predictors of PSD 3 months following stroke differed based on the presence of baseline depression. Our data suggest that PSD pathophysiology is heterogeneous; therefore, different therapeutic strategies may be needed to prevent PSD emergence following stroke.
참고문헌 (27)
- Robinson RG, "Post-stroke depression: a review", Am J Psychiatry, 173, pp.221~231 (2016)[DOI]
- Kim JS, "Poststroke depression and emotional incontinence: correlation with lesion location", Neurology, 54, pp.1805~1810 (2000)[DOI]
- Parikh RM, "The impact of poststroke depression on recovery in activities of daily living over a 2-year follow-up", Arch Neurol, 47, pp.785~789 (1990)[DOI]
- House A, "Mood disorders in the year after first stroke", Br J Psychiatry, 158, pp.83~92 (1991)[DOI]
- Wade DT, "Depressed mood after stroke. A community study of its frequency", Br J Psychiatry, 151, pp.200~205 (1987)[DOI]
- Astrom M, "Major depression in stroke patients. A 3-year longitudinal study", Stroke, 24, pp.976~982 (1993)[DOI]
- Farner L, "Depressive symptoms in stroke patients: a 13 month followup study of patients referred to a rehabilitation unit", J Affect Disord, 127, pp.211~218 (2010)[DOI]
- Ayerbe L, "Natural history, predictors, and associations of depression 5 years after stroke: the South London Stroke Register", Stroke, 42, pp.1907~1911 (2011)[DOI]
- Jong S. Kim, "Post-stroke Mood and Emotional Disturbances: Pharmacological Therapy Based on Mechanisms", 대한뇌졸중영문학회지, 18(3), pp.244~255 (2016), 대한뇌졸중학회
- Naess H, "Serial NIHSS scores in patients with acute cerebral infarction", Acta Neurol Scand, 133, pp.415~420 (2016)[DOI]
- Kim JS, "Efficacy of early administration of escitalopram on depressive and emotional symptoms and neurological dysfunction after stroke: a multicentre, double-blind, randomised, placebocontrolled study", Lancet Psychiatry, 4, pp.33~41 (2017)[DOI]
- Kearns NP, "A comparison of depression rating scales", Br J Psychiatry, 141, pp.45~49 (1982)[DOI]
- Kim JS, "Inability to control anger or aggression after stroke", Neurology, 58, pp.1106~1108 (2002)[DOI]
- Brott T, "Measurements of acute cerebral infarction: a clinical examination scale", Stroke, 20, pp.864~870 (1989)[DOI]
- Nasreddine ZS, "The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment", J Am Geriatr Soc, 53, pp.695~699 (2005)[DOI]
- Higgins SL, "Cardiac resynchronization therapy for the treatment of heart failure in patients with intraventricular conduction delay and malignant ventricular tachyarrhythmias", J Am Coll Cardiol, 42, pp.1454~1459 (2003)[DOI]
- Kutlubaev MA, "Part II: predictors of depression after stroke and impact of depression on stroke outcome: an updated systematic review of observational studies", Int J Stroke, 9, pp.1026~1036 (2014)[DOI]
- Tombaugh TN, "The mini-mental state examination: a comprehensive review", J Am Geriatr Soc, 40, pp.922~935 (1992)[DOI]
- Jitapunkul S, "The abbreviated mental test: its use and validity", Age Ageing, 20, pp.332~336 (1991)[DOI]
- Poynter B, "Sex differences in the prevalence of post-stroke depression: a systematic review", Psychosomatics, 50, pp.563~569 (2009)[DOI]
- Reeves MJ, "Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes", Lancet Neurol, 7, pp.915~926 (2008)[DOI]
- Glader EL, "Sex differences in management and outcome after stroke: a Swedish national perspective", Stroke, 34, pp.1970~1975 (2003)[DOI]
- Salter KL, "Prevention of poststroke depression: does prophylactic pharmacotherapy work?", J Stroke Cerebrovasc Dis, 22, pp.1243~1251 (2013)[DOI]
- Bech P, "Effective dose of escitalopram in moderate versus severe DSM-IV major depression", Pharmacopsychiatry, 39, pp.128~134 (2006)[DOI]
- Poeck K, "Handbook of Clinical Neurology", pp.343~367 (1969), Elsevier
- Kim JS, "Post-stroke emotional incontinence after small lenticulocapsular stroke: correlation with lesion location", J Neurol, 249, pp.805~810 (2002)[DOI]
- Choi-Kwon S, "Poststroke depression and emotional incontinence: factors related to acute and subacute stages", Neurology, 78, pp.1130~1137 (2012)[DOI]