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Release: Dec. 4, 2002

(Photo: Robert G. Robinson, M.D., the Paul W. Penningroth Chair and head of psychiatry and the study's lead investigator.)

UI receives NIMH grant to study prevention of post-stroke depression

The National Institute of Mental Health has awarded University of Iowa Health Care researchers a five-year, nearly $3.7 million grant to study whether preventive treatment helps ward off depression in people who have had a stroke. Previous UI and other research provided evidence that reducing or eliminating depression may significantly reduce the chances of post-stroke complications or even death.

Depression within days after a stroke currently affects approximately 40 percent of the nearly 400,000 individuals in the United States who annually survive a stroke. Another 25 percent of survivors develop depression within two years of their stroke.

Because stroke, including related complications, is the third leading cause of death in adults in the United States, reducing the death rate by 50 percent would help save hundreds of thousands of lives, said Robert G. Robinson, M.D., the Paul W. Penningroth Chair and head of psychiatry and the study's lead investigator.

"This study will attempt to answer the most important question that remains in post-stroke depression treatment and that is whether prophylactic, or preventive, antidepressant treatment should be given to all stroke patients," Robinson said. "Our previous research suggests it will help their recovery from stroke by decreasing emotional, physical, cognitive, and even fatal consequences of depression."

The study will focus on non-depressed stroke patients within the first three months of their stroke. During the first year of their participation in the study, patients will receive psychotherapy, a medication called escitalopram or a placebo (inactive pill).

Any patients who develop depression that lasts two weeks or longer during the study period will be screened and taken out of the study so that their depression can be appropriately treated. The remaining, non-depressed study participants will then be followed for another six months before the researchers analyze the findings.

Previous UI studies showed that post-stroke depression within the first year after a stroke can significantly decrease a person's ability to recover cognitive skills such as attention and memory, as well as abilities for daily tasks such as washing and dressing. However, treatment that improves the mood of people with depression following stroke appears to help them feel better emotionally and physically and improve their mental abilities.

Previous data also indicate that antidepressant treatment for post-stroke patients, whether they have depression or not, cuts their risk of death by more than half, Robinson said.

"This study has the potential to significantly impact the treatment of patients with stroke because it would represent one of the most important changes in the care of stroke patients since the introduction of clot-busting drugs such as TPA," Robinson said. "It also is one of the first times that we are focusing on a mental disorder and undertaking what really is the goal of much of medicine -- prevention."

In addition to the UI, institutions participating in the study include the University of Chicago Pritzker School of Medicine and the Joan and Sanford I. Weill Medical College at Cornell University, which is participating through the Burke Rehabilitation Hospital.

University of Iowa Health Care describes the partnership between the UI Roy J. and Lucille A. Carver College of Medicine and UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide. Visit UI Health Care online at www.uihealthcare.com.