Differences in therapeutic responses and factors affecting post-stroke depression at a later stage according to baseline depression

EMOTION investigators

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)258-267
Number of pages10
JournalJournal of Stroke
Volume20
Issue number2
DOIs
Publication statusPublished - 2018 May 1
Externally publishedYes

Fingerprint

Stroke
Depression
Citalopram
Therapeutics
Affective Symptoms
Random Allocation
Placebos

Keywords

  • Anger
  • Depression
  • Emotional incontinence
  • Escitalopram
  • Stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Differences in therapeutic responses and factors affecting post-stroke depression at a later stage according to baseline depression. / EMOTION investigators.

In: Journal of Stroke, Vol. 20, No. 2, 01.05.2018, p. 258-267.

Research output: Contribution to journalArticle

@article{e265137a22bf4e13b4d94be8285ae7f7,
title = "Differences in therapeutic responses and factors affecting post-stroke depression at a later stage according to baseline depression",
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.",
keywords = "Anger, Depression, Emotional incontinence, Escitalopram, Stroke",
author = "{EMOTION investigators} and Lee, {Eun Jae} and Kim, {Jong S.} and Chang, {Dae Il} and Park, {Jong Ho} and Ahn, {Seong Hwan} and Cha, {Jae Kwan} and Heo, {Ji Hoe} and Sohn, {Sung Il} and Lee, {Byung Chul} and Kim, {Dong Eog} and Kim, {Hahn Young} and Seongheon Kim and Do-Young Kwon and Jei Kim and Seo, {Woo Keun} and Jun Lee and Park, {Sang Won} and Koh, {Seong Ho} and Kim, {Jin Young} and Smi Choi-Kwon and Kim, {Min Sun} and Lee, {Ji Sung}",
year = "2018",
month = "5",
day = "1",
doi = "10.5853/jos.2017.02712",
language = "English",
volume = "20",
pages = "258--267",
journal = "Journal of Stroke",
issn = "2287-6391",
publisher = "Korean Stroke Society",
number = "2",

}

TY - JOUR

T1 - Differences in therapeutic responses and factors affecting post-stroke depression at a later stage according to baseline depression

AU - EMOTION investigators

AU - Lee, Eun Jae

AU - Kim, Jong S.

AU - Chang, Dae Il

AU - Park, Jong Ho

AU - Ahn, Seong Hwan

AU - Cha, Jae Kwan

AU - Heo, Ji Hoe

AU - Sohn, Sung Il

AU - Lee, Byung Chul

AU - Kim, Dong Eog

AU - Kim, Hahn Young

AU - Kim, Seongheon

AU - Kwon, Do-Young

AU - Kim, Jei

AU - Seo, Woo Keun

AU - Lee, Jun

AU - Park, Sang Won

AU - Koh, Seong Ho

AU - Kim, Jin Young

AU - Choi-Kwon, Smi

AU - Kim, Min Sun

AU - Lee, Ji Sung

PY - 2018/5/1

Y1 - 2018/5/1

N2 - 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.

AB - 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.

KW - Anger

KW - Depression

KW - Emotional incontinence

KW - Escitalopram

KW - Stroke

UR - http://www.scopus.com/inward/record.url?scp=85047899809&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85047899809&partnerID=8YFLogxK

U2 - 10.5853/jos.2017.02712

DO - 10.5853/jos.2017.02712

M3 - Article

AN - SCOPUS:85047899809

VL - 20

SP - 258

EP - 267

JO - Journal of Stroke

JF - Journal of Stroke

SN - 2287-6391

IS - 2

ER -