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Rising Depressive Symptoms May Foreshadow Stroke
Increasing depressive symptoms may be a sign of incident stroke, suggest new findings published online ahead of print in the journal Neurology.
“Depression is among the most pressing problems in people who have had a stroke, and it is so common it is referred to as post-stroke depression,” said study author Maria Blöchl, PhD, University of Münster, Germany. “But our study found depressive symptoms not only markedly increase after stroke, it found people already had developed some depressive symptoms before the stroke even occurred.”
To examine the trajectory of depression symptoms before and after stroke, Dr Blöchl and colleague Steffen Nestler, PhD, followed 10,797 adults, average age 65, without a history of stroke for up to 12 years. Every 2 years, participants completed a questionnaire about depressive symptoms experienced over the past week: feeling depressed, feeling lonely, feeling sad, feeling like everything is an effort, and restless sleep. Scores of 3 points or higher signaled probable clinical depression.
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During the follow-up period, 425 participants had a stroke. Researchers used propensity scores to match participants with stroke to 4249 participants who did not experience stroke for age, gender, education, ethnicity, and vascular risk factors.
According to the study, average scores for the stroke group and the stroke-free group were similar, at about 1.6 points, 6 years before the stroke occurred. However, about 2 years before the stroke, scores increased an average 0.33 points in the stroke group. After the stroke, depressive symptoms in the stroke group increased an additional 0.23 points, reaching a total of approximately 2.1 points, where they remained for the next decade. People who did not experience a stroke showed stable depressive symptom scores throughout the study.
When researchers looked at proportions of participants with probable clinical depression, 29% of those in the stroke group and 24% of those in the stroke-free group met criteria at the pre-stroke assessment. At the time of the stroke, 34% in the stroke group met probable depression criteria compared with 24% in the stroke-free group. Six years afterward, proportions in both groups remained the same as when the stroke occurred.
Differences between groups were most pronounced for mood- and fatigue-related symptoms, analysis revealed.
“Depression is not only a post-stroke issue, but also a pre-stroke phenomenon,” said Dr Blöchl. “Whether these pre-stroke changes can be used to predict who will have a stroke is unclear. Exactly why depressive symptoms occur pre-stroke needs to be investigated in future research. Also, the study underscores why doctors need to monitor for symptoms of depression long term in people who have had strokes.”
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