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Differences in Therapeutic Responses and Factors Affecting Post-Stroke Depression at a Later Stage According to Baseline Depression

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Author(s)
Eun-Jae LeeJong S. KimDae-Il ChangJong-Ho ParkSeong Hwan AhnJae-Kwan ChaJi Hoe HeoSung-Il SohnByung-Chul LeeDong-Eog KimHahn Young KimSeongheon KimDo-Young KwonJei KimWoo-Keun SeoJun LeeSang-Won ParkSeong-Ho KohJin Young KimSmi Choi-KwonMin-Sun KimJi Sung Leefor the EMOTION Investigators
Keimyung Author(s)
Sohn, Sung Il
Department
Dept. of Neurology (신경과학)
Journal Title
Journal of Stroke
Issued Date
2018
Volume
20
Issue
2
Keyword
AngerDepressionEmotional incontinenceEscitalopramStroke
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.
Keimyung Author(s)(Kor)
손성일
Publisher
School of Medicine (의과대학)
Citation
Eun-Jae Lee et al. (2018). Differences in Therapeutic Responses and Factors Affecting Post-Stroke Depression at a Later Stage According to Baseline Depression. Journal of Stroke, 20(2), 258–267. doi: 10.5853/jos.2017.02712
Type
Article
ISSN
2287-6391
DOI
10.5853/jos.2017.02712
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/41187
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Neurology (신경과학)
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