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Risk Factors for and Correlates of Poststroke Depression Following Discontinuation of Antidepressants

Received February 17, 2006; revised October 14, 2007; accepted December 4, 2006. Drs. Fiedorowicz, Takezawa and Robinson are affiliated with the Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa. Dr. Takezawa is also affiliated with the Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan. Address correspondence to Dr. Fiedorowicz, Department of Psychiatry, The University of Iowa Hospitals and Clinics, 500 Newton Rd., I-289 MEB, Iowa City, IA 52242; jess-fiedorowicz{at}uiowa.edu (e-mail).

The authors randomly assigned nondepressed patients at least 3 months poststroke to receive nortriptyline, fluoxetine, or placebo for 3 months using double-blind methodology. Patients were followed at 3, 6, 9, and 21 months for new onset of depression. In patients treated with antidepressants, lesion volume and degree of social impairment were associated with subsequent late-onset of poststroke depression at 6 and 9 months. In the placebo group, severity of impairment in activities of daily living, at 3 and 9 months, was associated with late onset poststroke depression. Differences in the clinical/pathological correlates may reflect subtle differences in the pathophysiology of poststroke depression following prophylactic antidepressants.

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