Detection and treatment of post-stroke depression: results from the Registry of the Canadian Stroke Network

Background — Depression occurs in approximately one-third of patients following stroke based on studies that screen entire stroke populations. Less is known about the detection and treatment of post stroke depression (PSD) in routine clinical practice.

Methods — This was a prospective cohort study of 7643 consecutive stroke patients >66 years of age, from 13 designated stroke centres in Ontario, Canada. PSD was defined as (a) presence of strong evidence of depression documented in the patient chart plus a prescribed antidepressant and a psychiatric consult, or (b) prescription of a new antidepressant following admission. The prevalence of PSD was determined and patients with and without PSD were compared on a variety of measures. Patients admitted to specialized stroke units were compared to patients admitted to standard units in order to determine if PSD detection and treatment rates differed.

Results — PSD was diagnosed in 4.8%, and 6.7% were treated with a new antidepressant. Patients with PSD had more severe strokes, more functional handicap, longer hospital stays and were less likely to be discharged home (all p < 0.001). Patients admitted to specialized stroke units were more likely to be diagnosed with depression (5.2% vs 4.0%, p < 0.014) and were more likely to receive a new prescription for an antidepressant (7.8% vs 4.5%; p < 0.001).

Conclusions — Rates of diagnosed and treated PSD in routine clinical practice are low and appear significantly lower than those from studies that utilize active screening of entire stroke populations. These results support the routine screening of all patients for PSD using validated instruments. Specialized stroke unit care may improve PSD detection and treatment rates.