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August 16, 2018Psychosomatic MedicineOpen Access

Comparison of Treatment Rates of Depression After Stroke Versus Myocardial Infarction: A Systematic Review and Meta-Analysis of Observational Data

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Key result

Antidepressant medication was used by 24% of patients with post-stroke depression and 14% of patients with post-myocardial infarction depression, indicating significant undertreatment in both conditions.

Why the study?

What are the treatment rates of depression in adults following stroke or myocardial infarction?

Population

Adults with depression after stroke or myocardial infarction from prospective observational studies with…

Design

Meta-analysis

Authors

SLSimon LadwigBielefeld UniversityZZZien ZhouShanghai Jiao Tong UniversityYXYing XuJiangsu University

Discussion

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Implication

Undertreatment of depression after stroke and MI persists; leaves open barriers to care and need for intervention trials.

Study Design

Type

Meta-Analysis (n=19,705)

Structured PICO

What are the treatment rates of depression in adults following stroke or myocardial infarction?

P
Population
Adults with depression after stroke or myocardial infarction (MI) from prospective observational studies with consecutive recruitment. 55 studies reported 32 stroke cohorts (n = 8,938) and 17 MI cohorts (n = 10,767).
I
Intervention
Antidepressant treatment (medication or psychosocial interventions)
O
Outcome
Treatment rates of depression (use of antidepressant medication or psychosocial interventions)

Main Result

Absolute Event Rate: 24% vs 14%

Despite the high prevalence of depression following stroke and myocardial infarction, treatment rates remain remarkably low, with only 24% of depressed stroke patients and 14% of depressed MI patients receiving antidepressant medication.

Limitations

  • High variability of assessment tools, criteria for depressive symptoms, assessment times, and methods for collecting data on treatment use
  • Reported use of antidepressants may not indicate adequate treatment of depression as they may also be prescribed to improve physical rehabilitation or treat anxiety
  • Exclusion of interventions solely providing information or education
  • Exclusion of cohorts assessing depressive symptoms in general coronary diseases rather than solely myocardial infarction

Cite This Study

Ladwig et al. (2018) conducted a meta-analysis in Depression after stroke or myocardial infarction (n=19,705). Antidepressant medication vs. Myocardial infarction cohort (compared to stroke cohort) was evaluated on Frequency of antidepressant medication use in depressed patients. Antidepressant medication was used by 24% of patients with post-stroke depression and 14% of patients with post-myocardial infarction depression, indicating significant undertreatment in both conditions.

synapsesocial.com/papers/6a10ef61497e609eda647a04https://doi.org/10.1097/psy.0000000000000632
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis of 25 years of research2011 · 557 citations
  2. 2Lessons From SADHART, ENRICHD, and Other Trials2005 · 83 citations
  3. 3Prognostic value of one-year course of symptoms of anxiety and depression in patients with coronary heart disease: Role of physical activity and unmet medical need2014 · 13 citations
  4. 4Post-stroke depression and functional outcome: a cohort study investigating the influence of depression on functional recovery from stroke1999 · 193 citations
  5. 5Depressive Disorders in Long-Term Survivors of Stroke1994 · 116 citations