Depression occurs in as many as one-third of patients after a stroke, and women are at somewhat higher risk, according to a large new review of studies. Post-stroke depression is associated with greater disability, reduced quality of life and an increased risk of death.
The systematic review appears in the November-December issue of the journal Psychosomatics.
Brittany Poynter, M.D., and colleagues from the University of Toronto looked at 56 studies on stroke and depression comprising more than 75,000 people, about 12,000 of them women. The time between the stroke and onset of depression ranged from less than two weeks to 15 years.
In women, rates of post-stroke depression ranged from about 6 percent to 78 percent, while in men depression rates ranged from 4.7 percent to about 65 percent.
These findings are important, Poynter said, because women who have had a stroke generally do more poorly than men. They tend to have higher rates of disability and longer hospitalization times. The authors say this might be due in part to higher rates of depression. In addition, "women may have less access to care," Poynter said.
"People think of stroke as a 'male' disease -- and it is slightly more common in men -- but because it increases with age, more women end up having strokes because they live longer," said Linda S. Williams, M.D., chief of neurology at the Roudebush VA Medical Center in Indianapolis. She is not associated with the review.
"Post-stroke depression is often unrecognized, both by the patient and the provider," Williams said. "Patients may have symptoms, but they think that's a natural reaction to having a stroke. Providers may think it is natural that the patient feels down after having this major life event. So there is a watch-and-see approach instead of a more of an aggressive screening-and-treatment approach."
It is uncertain what the best treatments for post-stroke depression might be. "There may be multiple treatments beyond antidepressants and counseling, such as exercise, physical rehabilitation and support groups," Poynter said. "A multimodal approach may be the most effective."
Both Poynter and Williams emphasized that all stroke patients should be routinely screened for depression.
- Poynter B, et al. Sex differences in the prevalence of post-stroke depression: a systematic review. Psychosomatics, 50(6), 2009
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