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Release: July 7, 2000

UI study finds post-stroke depression treatment can also help restore mental abilities

IOWA CITY, Iowa -- Treatment that improves the mood of people with major depression following stroke can also help them recover their mental abilities, according to a study by University of Iowa Health Care researchers and a visiting physician from Nippon Medical School in Tokyo.

The study is the first to find that treating major depression can improve post-stroke recovery of intellectual functions associated with language, attention, memory and hand-eye coordination. The finding was based on treatment with nortriptyline (Aventyl or Pamelor), a tricyclic antidepressant previously shown by UI researchers to effectively treat post-stroke depression. The report was published in the July issue of Stroke: Journal of the American Heart Association.

"We have known for nearly 15 years that there is a relationship between depression and cognitive problems in elderly patients with post-stroke depression," said Robert G. Robinson, M.D., UI professor and head of psychiatry and the study's principal investigator. "However, three of our prior post-stroke studies did not show improved cognitive function in patients even when antidepressant treatment helped treat their depression. In this study we looked at the data in a different way and found that when patients responded to treatment there was an associated cognitive improvement."

He added that the finding shows how important it is to identify and treat major depression in patients within weeks of their stroke. Previous research by Robinson and others showed that cognitive impairment is associated with major, not minor, post-stroke depression.

"If one medication does not work, then others should be tried until the depression goes into remission," he said. "While we found that nortriptyline was effective, other drugs, including newer ones such as Celexa, may be equally effective. What is most important about our finding is that treatment is possible."

The study combined data from three double-blind treatment studies and included 33 patients with major depression and 14 patients with minor depression, none of whom had a heart condition. Twenty-one of the patients received nortriptyline for six to 12 weeks and 26 patients received a placebo. Of the 21 patients who took nortriptyline, 74 percent showed cognitive and mood improvement. In contrast, only 31 percent of the patients who took the placebo showed significant improvement in both areas.

"The finding also supports our contention that post-stroke depression leads to cognitive impairment rather than cognitive impairment producing the depression," Robinson said. Brain damage caused by stroke was already known to cause cognitive impairment.

Robinson added that because post-stroke mental impairment involves more than one type of cognitive function such as memory, attention and concentration, the disorder is likely a dementia similar to that found in patients with Alzheimer's disease. However, the dementia associated with post-stroke depression does not progress as in cases involving Alzheimer's disease.

Post-stroke depression affects nearly 40 percent of the 400,000 individuals in the United States who annually survive a stroke.

The study was funded in part by grants from the National Institute of Mental Health, a federal research scientist award and a grant from Nippon Medical School Department of Neuropsychiatry.


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