1
|
Raggi A, Serretti A, Ferri R. A comprehensive overview of post-stroke depression treatment options. Int Clin Psychopharmacol 2024; 39:127-138. [PMID: 38170802 DOI: 10.1097/yic.0000000000000532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Nearly one-third of all stroke patients develop depression at any time after a stroke, and its presence is associated with unfavorable outcomes. This narrative review aims to provide a synopsis of possible pharmacological and non-pharmacological treatment modalities for post-stroke depression (PSD). Several studies have demonstrated the efficacy and safety of selective serotonin reuptake inhibitors in treating the symptoms of this clinical condition. The treatment of PSD has been recently enhanced by innovative approaches, such as cognitive-behavioral therapy, virtual reality, telehealth, repetitive transcranial magnetic stimulation, and non-conventional therapies, which might improve depression treatment in stroke survivors. Future high-quality randomized controlled trials are necessary to confirm this hypothesis.
Collapse
Affiliation(s)
- Alberto Raggi
- Unit of Neurology, G.B. Morgagni - L. Pierantoni Civic Hospital, Forlì
| | | | - Raffaele Ferri
- Department of Neurology, Oasi Research Institute - IRCCS, Troina, Italy
| |
Collapse
|
2
|
Blaszczyk AT, Mathys M, Le J. A Review of Therapeutics for Treatment-Resistant Depression in the Older Adult. Drugs Aging 2023; 40:785-813. [PMID: 37596380 DOI: 10.1007/s40266-023-01051-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 08/20/2023]
Abstract
One-third of older adults with depression meet criteria for treatment resistance, typically defined as a lack of response to two or more adequate trials of an antidepressant. Treatment resistance contributes to an unfavorable prognosis, compromised medical outcomes, heightened disability, accelerated cognitive decline, and an elevated risk of developing dementia. Despite this significant morbidity, evidence is sparse for how to proceed with treatment in this population. Non-pharmacologic therapy (e.g., diet, psychotherapy) can be utilized as adjunctive therapy, despite little published evidence of benefit, given that the risks are low. Pharmacotherapy trials in the treatment-resistant late-life depression population lack strong methods and external validity; however, the use of venlafaxine as monotherapy and add-on therapy, as well as lithium, bupropion, or aripiprazole as add-on therapy to standard antidepressant therapy, have enough evidence that a trial with appropriate monitoring is a prudent strategy. Electroconvulsive therapy remains a well-studied safe therapy, especially when used as maintenance treatment once an initial cycle is completed but is traditionally underutilized in the treatment-resistant late-life depression population. Ensuring non-pharmacologic and pharmacologic strategies are optimized and given a sufficient trial in those with treatment-resistant late-life depression is the best we can do for this vulnerable population.
Collapse
Affiliation(s)
- Amie Taggart Blaszczyk
- Department of Pharmacy Practice, Texas Tech University HSC School of Pharmacy-Dallas/Fort Worth, 5920 Forest Park Rd, Dallas, TX, USA.
| | - Monica Mathys
- Department of Pharmacy Practice, Texas Tech University HSC School of Pharmacy-Dallas/Fort Worth, 5920 Forest Park Rd, Dallas, TX, USA
| | - Jennifer Le
- Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
| |
Collapse
|
3
|
Evidence That Methylphenidate Treatment Evokes Anxiety-Like Behavior Through Glucose Hypometabolism and Disruption of the Orbitofrontal Cortex Metabolic Networks. Neurotox Res 2021; 39:1830-1845. [PMID: 34797528 DOI: 10.1007/s12640-021-00444-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
Methylphenidate (MPH) has been widely misused by children and adolescents who do not meet all diagnostic criteria for attention-deficit/hyperactivity disorder without a consensus about the consequences. Here, we evaluate the effect of MPH treatment on glucose metabolism and metabolic network in the rat brain, as well as on performance in behavioral tests. Wistar male rats received intraperitoneal injections of MPH (2.0 mg/kg) or an equivalent volume of 0.9% saline solution (controls), once a day, from the 15th to the 44th postnatal day. Fluorodeoxyglucose-18 was used to investigate cerebral metabolism, and a cross-correlation matrix was used to examine the brain metabolic network in MPH-treated rats using micro-positron emission tomography imaging. Performance in the light-dark transition box, eating-related depression, and sucrose preference tests was also evaluated. While MPH provoked glucose hypermetabolism in the auditory, parietal, retrosplenial, somatosensory, and visual cortices, hypometabolism was identified in the left orbitofrontal cortex. MPH-treated rats show a brain metabolic network more efficient and connected, but careful analyses reveal that the MPH interrupts the communication of the orbitofrontal cortex with other brain areas. Anxiety-like behavior was also observed in MPH-treated rats. This study shows that glucose metabolism evaluated by micro-positron emission tomography in the brain can be affected by MPH in different ways according to the region of the brain studied. It may be related, at least in part, to a rewiring in the brain the metabolic network and behavioral changes observed, representing an important step in exploring the mechanisms and consequences of MPH treatment.
Collapse
|
4
|
Sassi KLM, Rocha NP, Colpo GD, John V, Teixeira AL. Amphetamine Use in the Elderly: A Systematic Review of the Literature. Curr Neuropharmacol 2020; 18:126-135. [PMID: 31660835 PMCID: PMC7324882 DOI: 10.2174/1570159x17666191010093021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/01/2019] [Accepted: 09/30/2019] [Indexed: 11/25/2022] Open
Abstract
Objective: To systematically review the literature on the therapeutic use of amphetamine, lisdexamfetamine and methylphenidate in elderly population with and without dementia. Methods: We conducted two researches on the PubMed, Scopus and Embase using the keywords (“elderly”) AND (“amphetamine” OR “methylphenidate” OR “lisdexamfetamine”) and then (“Alzheimer” OR “dementia”) AND (“amphetamine” OR “methylphenidate” OR “lisdexamfetamine”). Results: Twenty-nine papers met all the eligibility criteria. The results are encouraging as 81.5% of the studies showed clinical improvement of the investigated condition. Conclusion: Amphetamines and methylphenidate are probably effective strategies for different conditions in the elderly population. However, further studies are needed to provide more robust evidence on efficacy, dosage and safety for this population.
Collapse
Affiliation(s)
- Karina Lúcia Moreira Sassi
- Department of Psychiatry and Behavioral Science, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Natalia Pessoa Rocha
- Department of Psychiatry and Behavioral Science, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Gabriela Delevati Colpo
- Department of Psychiatry and Behavioral Science, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Vineeth John
- Department of Psychiatry and Behavioral Science, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Antonio Lucio Teixeira
- Department of Psychiatry and Behavioral Science, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| |
Collapse
|
5
|
Kalinowski L, Connor C, Somanesan R, Carias E, Richer K, Smith L, Martin C, Mackintosh M, Popoola D, Hadjiargyrou M, Komatsu DE, Thanos PK. Brief and extended abstinence from chronic oral methylphenidate treatment produces reversible behavioral and physiological effects. Dev Psychobiol 2020; 62:170-180. [PMID: 31456229 PMCID: PMC7028498 DOI: 10.1002/dev.21902] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 06/25/2019] [Accepted: 06/28/2019] [Indexed: 01/01/2023]
Abstract
Methylphenidate (MP) is a commonly prescribed psychostimulant to individuals with Attention Deficit Hyperactivity Disorder, and is often used illicitly among healthy individuals with intermittent breaks to coincide with breaks from school. This study examined how intermittent abstinence periods impact the physiological and behavioral effects of chronic oral MP self-administration in rats, and whether these effects persist following prolonged abstinence from the drug. Rats were treated orally with water, low-dose (LD), or high-dose (HD) MP, beginning at PND 28. This daily access continued for three consecutive weeks followed by a 1-week abstinence; after three repeats of this cycle, there was a 5-week abstinence period. Throughout the study, we examined body weight, food intake, locomotor activity, and anxiety- and depressive-like behaviors. During the treatment phase, HD MP decreased body weight, food intake, and depressive- and anxiety-like behaviors, while it increased locomotor activity. During intermittent abstinence, the effects of MP on locomotor activity were eliminated. During prolonged abstinence, most of the effects of HD MP were ameliorated to control levels, with the exception of weight loss and anxiolytic effects. These findings suggest that intermittent exposure to chronic MP causes physiological and behavioral effects that are mostly reversible following prolonged abstinence.
Collapse
Affiliation(s)
- Leanna Kalinowski
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY, USA
- University at Buffalo, Department of Psychology, Buffalo, NY, USA
| | - Carly Connor
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY, USA
| | - Rathini Somanesan
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY, USA
| | - Emily Carias
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY, USA
| | - Kaleigh Richer
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY, USA
- University at Buffalo, Department of Psychology, Buffalo, NY, USA
| | - Lauren Smith
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY, USA
| | - Connor Martin
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY, USA
| | - Macauley Mackintosh
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY, USA
| | - Daniel Popoola
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY, USA
| | - Michael Hadjiargyrou
- New York Institute of Technology, Department of Life Sciences, Old Westbury, NY, USA
| | - David E. Komatsu
- Stony Brook University, Department of Orthopedics, Stony Brook, NY, USA
| | - Panayotis K. Thanos
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY, USA
- University at Buffalo, Department of Psychology, Buffalo, NY, USA
| |
Collapse
|
6
|
Abstract
SummaryPsychostimulants (dexamphetamine, methylphenidate, modafinil) reduce fatigue, promote alertness and wakefulness, and have possible mood-enhancing properties. In modern psychiatric practice, their use has been limited to attention-deficit hyperactivity disorder and sleep disorders such as narcolepsy. Despite this, research has continued into psychostimulant use in general psychiatry, especially in the treatment of depression and fatigue. This article reviews the recent literature regarding psychostimulant use in general and consultation-liaison psychiatry. Although psychostimulants continue to attract clinical research, there is currently not enough evidence to recommend their routine use for general psychiatric conditions.
Collapse
|
7
|
[Psychostimulants for late life depression]. Encephale 2017; 44:274-279. [PMID: 29195804 DOI: 10.1016/j.encep.2017.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 09/19/2017] [Accepted: 09/23/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The use of psychostimulants in the treatment of depressive disorders is receiving renewed interest. Recent publications suggest a particular interest of psychostimulants in the treatment of depression in the elderly. The aim of this article is to review the literature on the role of psychostimulants in the treatment of depression in older adults. METHODS The literature review focused on efficacy and tolerability studies of psychostimulants in the treatment of depression for the elderly that were published between 1980 and 2016. The only inclusion criterion applied was an average age of the sample studied greater than or equal to 60 years. RESULTS Overall, 12 trials were selected: 3 controlled trials and 9 uncontrolled trials. Of the 3 controlled trials, one compared parallel groups and the other two were cross-tests. Among the psychostimulants, methylphenidate was the most studied molecule. The trials demonstrate an efficacy of this molecule in particular as an add-on therapy in old-age depression but for the most part with a level of proof that remains insufficient. CONCLUSIONS The small size of the samples and the methodological limitations of the studies obviate the possibility of extracting definitive conclusions concerning the place of psychostimulants in the treatment of depression in the elderly. Further studies are required in particular in the treatment of resistant depressive episodes.
Collapse
|
8
|
Woessner R, Caplan B. Emotional Distress Following Stroke: Interpretive Limitations of the SCL-90-R. Assessment 2016. [DOI: 10.1177/1073191196003003009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Evaluation of affective status in medical patients is frequently hampered by the uncertain validity, questionable relevance, or both, of certain items on measures used for this purpose. In this study, we examined the validity of the Symptom Checklist-90-Revised (SCL-90-R) as a measure of psychological distress in stroke patients. Those SCL-90-R symptoms (N = 19) that were designated by at least 8 of 10 expert raters as "usual consequences of stroke" were labeled "stroke symptoms." These items loaded primarily on the Somatization, Obsessive-Compulsive, and Depression scales. Among a sample of 30 patients hospitalized for acute rehabilitation following unilateral stroke, average scores fell at or above the 70th percentile (relative to normative data given in the manual) on five of the nine symptom dimensions and on all three summary indices of distress. Significantly elevated rates of endorsement were found in the stroke group on 12 of the 19 "stroke symptoms" and on 20 of the remaining symptoms as well. Participants with right-hemisphere lesions generally reported higher levels of distress than did the smaller group of patients with left hemisphere involvement. Our study suggests that at least some portion of SCL-90-R elevations is likely to be attributable to endorsement of phenomena that comprise part of the "natural history" of stroke. Our findings underscore the need for clinicians to examine individual responses of neurological patients on such self-report measures, as simple interpretation of summary scale scores can be highly misleading.
Collapse
|
9
|
Ruddy KJ, Barton D, Loprinzi CL. Laying to rest psychostimulants for cancer-related fatigue? J Clin Oncol 2014; 32:1865-7. [PMID: 24799492 DOI: 10.1200/jco.2014.55.8353] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
|
10
|
Drye LT, Scherer RW, Lanctôt KL, Rosenberg PB, Herrmann N, Bachman D, Mintzer JE. Designing a trial to evaluate potential treatments for apathy in dementia: the apathy in dementia methylphenidate trial (ADMET). Am J Geriatr Psychiatry 2013; 21:549-59. [PMID: 23567407 PMCID: PMC3402588 DOI: 10.1016/j.jagp.2012.12.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 11/03/2011] [Accepted: 11/30/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND Research on efficacious treatments for apathy in Alzheimer disease has been hindered by a lack of consensus diagnosis, difficulties in measurement, and studies with small sample sizes. METHODS In designing the Apathy in Dementia Methylphenidate Trial (ADMET), a trial to evaluate the efficacy and safety of methylphenidate for the treatment of apathy in Alzheimer disease, we encountered the following issues: defining and measuring apathy, distinguishing apathy and depression, determining an appropriate test treatment, selecting relevant secondary outcomes, recruiting participants, and deciding on a suitable method for treatment unmasking. ADMET is a 6-week randomized, double-masked, placebo-controlled multicenter clinical trial with two parallel treatment groups assigned in a 1:1 ratio with randomization stratified by clinical center. The recruitment goal is 60 randomized participants over 2 years. The primary outcomes are change in apathy severity as measured by the Apathy Evaluation Scale and the Alzheimer Disease Cooperative Study-Clinical Global Impression of Change. CONCLUSION The design decisions made for ADMET are important elements to be considered in trials assessing the safety and efficacy of medications for clinically significant apathy in Alzheimer disease.
Collapse
Affiliation(s)
- Lea T. Drye
- Johns Hopkins Bloomberg School of Public Health,Corresponding author: 615 North Wolfe Street, W5010, Baltimore, MD 21205, Phone (443) 287-3170, Fax (443) 287-5797,
| | | | | | - Paul B. Rosenberg
- Johns Hopkins School of Medicine and Johns Hopkins Bayview Medical Center
| | | | - David Bachman
- Medical University of South Carolina and Ralph H Johnson VA Medical Center
| | - Jacobo E. Mintzer
- Medical University of South Carolina and Ralph H Johnson VA Medical Center
| | | |
Collapse
|
11
|
Delbari A, Salman-Roghani R, Lokk J. Effect of Methylphenidate and/or Levodopa Combined with Physiotherapy on Mood and Cognition after Stroke: A Randomized, Double-Blind, Placebo-Controlled Trial. Eur Neurol 2011; 66:7-13. [DOI: 10.1159/000329275] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 05/09/2011] [Indexed: 11/19/2022]
|
12
|
Rehabilitation and Recovery of the Patient with Stroke. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10056-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
|
13
|
Abstract
Poststroke depression (PSD) in elderly patients has been considered the most common neuropsychiatric consequence of stroke up to 6-24 months after stroke onset. When depression appears within days after stroke onset, it is likely to remit, whereas depression at 3 months is likely to be sustained for 1 year. One of the major problems posed by elderly stroke patients is how to identify and optimally manage PSD. This review provides insight to identification and management of depression in elderly stroke patients. Depression following stroke is less likely to include dysphoria and more likely characterized by vegetative signs and symptoms compared with other forms of late-life depression, and clinicians should rely more on nonsomatic symptoms rather than somatic symptoms. Evaluation and diagnosis of depression among elderly stroke patients are more complex due to vague symptoms of depression, overlapping signs and symptoms of stroke and depression, lack of properly trained health care personnel, and insufficient assessment tools for proper diagnosis. Major goals of treatment are to reduce depressive symptoms, improve mood and quality of life, and reduce the risk of medical complications including relapse. Antidepressants (ADs) are generally not indicated in mild forms because the balance of benefit and risk is not satisfactory in elderly stroke patients. Selective serotonin reuptake inhibitors are the first choice of PSD treatment in elderly patients due to their lower potential for drug interaction and side effects, which are more common with tricyclic ADs. Recently, stimulant medications have emerged as promising new therapeutic interventions for PSD and are now the subject of rigorous clinical trials. Cognitive behavioral therapy can also be useful, and electroconvulsive therapy is available for patients with severe refractory PSD.
Collapse
Affiliation(s)
- Johan Lökk
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
| | | |
Collapse
|
14
|
Methylphenidate for the treatment of depressive symptoms, including fatigue and apathy, in medically ill older adults and terminally ill adults. ACTA ACUST UNITED AC 2009; 7:34-59. [PMID: 19281939 DOI: 10.1016/j.amjopharm.2009.02.006] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depressive symptoms, fatigue, and apathy are common symptoms among medically ill older adults and patients with advanced disease, and have been associated with morbidity and mortality. Methylphenidate has been used to treat these symptoms because of its rapid effect. Despite the long history of methylphenidate use for the treatment of depressive symptoms, fatigue, and apathy, there is little definitive evidence to support its use. OBJECTIVE The aim of this paper was to review the efficacy and tolerability of methylphenidate in the treatment of depressive symptoms, fatigue, and apathy in medically ill older adults and adults receiving palliative care. METHODS English-language articles presenting systematic reviews, clinical trials, or case series describing the use of methylphenidate for the treatment of depressive symptoms, fatigue, or apathy in medically ill older adults or adults receiving palliative care were identified. The key words methylphenidate and either depressive, depression, fatigue, or apathy were used to search the Cochrane Database, MEDLINE, PsycINFO, and International Pharmaceutical Abstracts. Included articles addressed depressive symptoms, fatigue, or apathy in (1) older adults (generally, age > or =65 years), particularly those with comorbid medical illness; (2) adults receiving palliative care; and (3) adults with other chronic illnesses. I excluded articles regarding treatment of depression in healthy young adults; bipolar disorder and attention-deficit/hyperactivity disorder; and narcolepsy, chronic fatigue syndrome, and related disorders. RESULTS A total of 19 controlled trials of methylphenidate in medically ill older adults or patients in palliative care were identified. Unfortunately, their conflicting results, small sample sizes, and poor methodologic quality limited the ability to draw inferences regarding the efficacy of methylphenidate, although evidence of tolerability was stronger. The available evidence suggests possible effectiveness of methylphenidate for depressive symptoms, fatigue, and apathy in various medically ill populations. CONCLUSION In the absence of definitive evidence of effectiveness, trials of low-dose methylphenidate in medically ill adults with depression, fatigue, or apathy, with monitoring for response and adverse effects, are appropriate.
Collapse
|
15
|
Ramasubbu R, Goodyear BG. Methylphenidate modulates activity within cognitive neural networks of patients with post-stroke major depression: A placebo-controlled fMRI study. Neuropsychiatr Dis Treat 2008; 4:1251-66. [PMID: 19337466 PMCID: PMC2646655 DOI: 10.2147/ndt.s4246] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Methylphenidate (MP) is a dopamine- and noradrenaline-enhancing agent beneficial for post-stroke depression (PSD) and stroke recovery due to its therapeutic effects on cognition, motivation, and mood; however, the neural mechanisms underlying its clinical effects remain unknown. This study used functional magnetic resonance imaging (f MRI) to investigate the effect of MP on brain activity in response to cognitive tasks in patients with PSD. METHODS Nine stroke outpatients with DSM IV defined major depression underwent fMRI during two cognitive tasks (2-back and serial subtraction) on four occasions, on the first and third day of a three-day treatment of MP and placebo. Nine healthy control (HC) subjects matched for age and sex scanned during a single session served as normative data for comparison. The main outcome measure was cognitive task-dependent brain activity. RESULTS For the 2-back task, left prefrontal, right parietal, posterior cingulate, and temporal and bilateral cerebellar regions exhibited significantly greater activity during the MP condition relative to placebo. Less activity was detected in rostral prefrontal and left parietal regions. For serial subtraction, greater activity was detected in medial prefrontal, biparietal, bitemporal, posterior cingulate, and bilateral cerebellar regions, as well as thalamus, putamen, and insula. Further, underactivation observed during the placebo condition relative to HC improved or reversed during MP treatment. No significant differences in behavioral measures were found between MP and placebo conditions or between patients and HC. CONCLUSIONS Short-term MP treatment may improve and normalize activity in cognitive neuronal networks in patients with PSD.
Collapse
Affiliation(s)
- Rajamannar Ramasubbu
- Department of Psychiatry and Clinical Neurosciences, Special Services Building, Room AW 258A, 1403 –29th Street NW, Calgary, Alberta, T2N 2T9, Canada.
| | | |
Collapse
|
16
|
Starkstein SE, Mizrahi R, Power BD. Antidepressant therapy in post-stroke depression. Expert Opin Pharmacother 2008; 9:1291-8. [PMID: 18473704 DOI: 10.1517/14656566.9.8.1291] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND About 40% of patients with stroke will develop depression at some stage after the acute event. Post-stroke depression (PSD) is associated with a poor prognosis. Depressed patients have more severe deficits in activities of daily living, a worse functional outcome, more severe cognitive deficits and increased mortality as compared to stroke patients without depression. OBJECTIVE This review will focus on available controlled trials of treatment for PSD. METHODS An unsystematic review of recent studies for the treatment of PSD. RESULTS Randomized controlled trials have demonstrated the efficacy of sertraline, citalopram and nortriptyline to treat post-stroke depression. Whether antidepressant medication may help to prevent post-stroke depression and decrease post-stroke mortality will require further controlled studies.
Collapse
Affiliation(s)
- Sergio E Starkstein
- University of Western Australia, School of Psychiatry and Clinical Neurosciences, Australia.
| | | | | |
Collapse
|
17
|
Herrmann N, Rothenburg LS, Black SE, Ryan M, Liu BA, Busto UE, Lanctôt KL. Methylphenidate for the treatment of apathy in Alzheimer disease: prediction of response using dextroamphetamine challenge. J Clin Psychopharmacol 2008; 28:296-301. [PMID: 18480686 DOI: 10.1097/jcp.0b013e318172b479] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Apathy is a common behavioral symptom of Alzheimer's disease (AD), being present in up to 70% of patients. Apathy in AD and non-AD populations has been associated with dysfunction in the dopaminergic brain reward system, suggesting that pharmacotherapeutic targeting of this system may be an effective treatment for apathy in AD. We therefore performed a randomized, double-blind, placebo-controlled crossover trial of methylphenidate in a sample of 13 apathetic AD patients (6 men, 7 women; age mean 77.9 years [SD, 7.8 years]; Mini Mental Status Examination score, 19.9 [SD, 4.7]). Patients were treated with methylphenidate (10 mg PO twice a day) or an identical placebo in two 2-week phases separated by a 1-week placebo washout. All patients participated in a dextroamphetamine challenge test (one 10-mg oral dose) before treatment with methylphenidate to gauge the functional integrity of the dopamine brain reward system. Overall, patients demonstrated greater improvement with methylphenidate compared with placebo according to Apathy Evaluation Scale total change scores (end of treatment - baseline: Wilcoxon Z = -2.00; P = 0.047). However, a significantly greater proportion of patients experienced at least 1 adverse event with methylphenidate compared with placebo (3 vs 1; chi = 4.33, P = 0.038). Two patients experienced serious adverse events with methylphenidate, consisting of delusions, agitation, anger, irritability, and insomnia, which resolved upon discontinuation of the medication. Response to methylphenidate was associated with increases in inattention on a continuous performance task after dextroamphetamine challenge. Psychostimulants may be effective in treating features of apathy in AD, and dopaminergic changes may predict response.
Collapse
Affiliation(s)
- Nathan Herrmann
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | |
Collapse
|
18
|
Abstract
Neuropsychiatric syndromes are common in the setting of cerebrovascular disease. The most frequent psychiatric syndrome after stroke is depression. Emotionalism and apathy after stroke are also frequent and under-detected symptoms. Treatment principles are broadly similar to those currently used to treat non-organically ill patients. The evidence for pharmacological and psychological treatment for depression after stroke is scant, and of variable quality. Currently there is evidence of efficacy for both tricyclic antidepressants and SSRIs in the management of depression but the latter are better tolerated. Randomized controlled trials of antidepressants for post-stroke emotionalism are positive and this is encouraging. The current evidence base for psychological interventions either as first line or augmentative strategies is too limited and inconclusive to permit definite recommendations. Future studies might include multi-modal interventions using the principles of active case management and pharmacological studies which target both specific neuropsychiatric symptoms and underlying cerebrovascular disorder.
Collapse
Affiliation(s)
- Raghu Paranthaman
- Edale House, Manchester Mental Health & Social Care Trust, Manchester Royal Infirmary, Manchester, UK
| | | |
Collapse
|
19
|
Papakostas GI. Dopaminergic-based pharmacotherapies for depression. Eur Neuropsychopharmacol 2006; 16:391-402. [PMID: 16413172 DOI: 10.1016/j.euroneuro.2005.12.002] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2005] [Revised: 11/22/2005] [Accepted: 12/01/2005] [Indexed: 01/11/2023]
Abstract
The serendipitous discovery of the precursors of two of the major contemporary antidepressant families during the late 1950s, iproniazid for the monoamine oxidase inhibitors (MAOIs) and imipramine for the tricyclic antidepressants (TCAs), has guided the subsequent development of antidepressant compounds with predominantly serotonergic, noradrenergic or combined serotonergic and noradrenergic activity. Unfortunately, however, many depressed patients continue to remain symptomatic despite adequate treatment with pharmacologic agents currently available. When one reviews the list of pharmacologic agents currently approved for the treatment of Major Depressive Disorder (MDD), it is apparent that relatively few treatments with dopaminergic activity have been developed to date. Therefore, developing effective antidepressant treatments with pro-dopaminergic properties which also possess a relatively wide safety margin may further improve the standard of care for depression. In the present article we will briefly review studies focusing on the role of dopamine in depression followed by a comprehensive review of pharmacotherapies for depression with pro-dopaminergic activity.
Collapse
Affiliation(s)
- George I Papakostas
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
| |
Collapse
|
20
|
Abstract
Stroke is an increasing public health concern throughout the world as the leading cause of long-term disability. It is well known that there exist differences related to epidemiology, pathophysiology, comorbidity, and functional outcome of stroke patients with advanced age compared with the young. Factors that have been suggested to influence this disparity include age-related complications, availability of resources, lack of aggressive management, and possible diminished capacity for neuroplasticity. This article reviews the current medical and rehabilitative aspects of stroke and the possible disparities related to advanced age.
Collapse
Affiliation(s)
- Monika V Shah
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, and Long-Term Acute Care Brain Injury Program, Kindred Hospital, 1333 Moursund Avenue, D-111, Houston, TX 77030, USA.
| |
Collapse
|
21
|
Rampello L, Battaglia G, Raffaele R, Vecchio I, Alvano A. Is it safe to use antidepressants after a stroke? Expert Opin Drug Saf 2005; 4:885-97. [PMID: 16111451 DOI: 10.1517/14740338.4.5.885] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Depression is an important complication of stroke. Although antidepressants are widely used for the treatment of poststroke depression (PSD), prescription is critically influenced by their safety, tolerability and by the impact on co-morbidities. The authors reviewed the literature on the use of antidepressants after stroke. Selective serotonin re-uptake inhibitors are effective and have a good profile of safety and tolerability in PSD. They are, therefore, used as first-line drugs in the treatment of PSD, although potential cardiovascular and cerebrovascular effects, drug-drug interactions and intolerability in a minority of patients have to be considered. Other antidepressants appear to be safe and effective in selected patients. PSD patients should be classified according to their clinical profile for the selection of the drug of choice in particular sub-groups of patients.
Collapse
Affiliation(s)
- Liborio Rampello
- Department of Neurosciences, University of Catania, Azienda Policlinico, via S. Sofia, 78 95123 Catania, Italy.
| | | | | | | | | |
Collapse
|
22
|
Lee H, Kim SW, Kim JM, Shin IS, Yang SJ, Yoon JS. Comparing effects of methylphenidate, sertraline and placebo on neuropsychiatric sequelae in patients with traumatic brain injury. Hum Psychopharmacol 2005; 20:97-104. [PMID: 15641125 DOI: 10.1002/hup.668] [Citation(s) in RCA: 151] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study aimed to investigate the effects of methylphenidate and sertraline compared with placebo on various neuropsychiatric sequelae associated with traumatic brain injury (TBI). METHODS This was a 4 week, double-blind, parallel-group trial. Thirty patients with mild to moderate degrees of TBI were randomly allocated to one of three treatment groups (n = 10 in each group) with matching age, gender and education, i.e. methylphenidate (starting at 5 mg/day and increasing to 20 mg/day in a week), sertraline (starting at 25 mg/day and increasing to 100 mg/day in a week) or placebo. At the baseline and at the 4 week endpoint, the following assessments were administered: subjective (Beck Depression Inventory) and objective (Hamilton Depression Rating Scale) measures of depression; Rivermead Postconcussion Symptoms Questionnaire for postconcussional symptoms; SmithKline Beecham Quality of Life Scale for quality of life; seven performance tests (Critical Flicker Fusion, Choice Reaction Time, Continuous Tracking, Mental Arithmetic, Short-Term memory, Digit Symbol Substitution and Mini-Mental State Examination); subjective measures of sleep (Leeds Sleep Evaluation Questionnaire) and daytime sleepiness (Epworth Sleepiness Scale). All adverse events during the study period were recorded and their relationships to the drugs were assessed. RESULTS Neuropsychiatric sequelae seemed to take a natural recovery course in patients with traumatic brain injury. Methylphenidate had significant effects on depressive symptoms compared with the placebo, without hindering the natural recovery process of cognitive function. Although sertraline also had significant effects on depressive symptoms compared with the placebo, it did not improve many tests on cognitive performances. Daytime sleepiness was reduced by methylphenidate, while it was not by sertraline. CONCLUSIONS Methylphenidate and sertraline had similar effects on depressive symptoms. However, methylphenidate seemed to be more beneficial in improving cognitive function and maintaining daytime alertness. Methylphenidate also offered a better tolerability than sertraline.
Collapse
Affiliation(s)
- Hoon Lee
- Department of Psychiatry and Research Institute of Medical Science, Chonnam National University Medical School, Kwangju, Republic of Korea
| | | | | | | | | | | |
Collapse
|
23
|
Tang WK, Ungvari GS, Chiu HFK, Sze KH. Detecting depression in Chinese stroke patients: a pilot study comparing four screening instruments. Int J Psychiatry Med 2005; 34:155-63. [PMID: 15387399 DOI: 10.2190/9yj9-nnxa-rjcy-2dyp] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine which screening instrument is most suitable for detecting depression in Chinese stroke patients. METHOD A random sample of 60 Chinese subjects recruited from consecutively admitted patients with first-ever stroke to a rehabilitation facility were assessed using the Visual Analogue Mood Scale (VAMS), the Hospital Anxiety and Depression Scale (HADS), and the Geriatric Depression Scale (GDS). Psychiatric diagnoses, which served as a benchmark for the comparison of screening instruments, were made using the SCID-DSM-III-R. Rating instruments were compared with respect to response rate, sensitivity, specificity, positive and negative predictive values, and receiver operating characteristic (ROC) curves. RESULTS The VAMS was not useful in screening for depression in Chinese stroke patients while both the HADS and the GDS demonstrated satisfactory accuracy in detecting depression in Chinese stroke patients. CONCLUSIONS Screening instruments for poststroke depression are culture-specific and even scales well established in other cultures should be tested before being used in clinical practice and research.
Collapse
Affiliation(s)
- Wai Kwong Tang
- Chinese University of Hong Kong, Shatin Hospital, Department of Psychiatry, Hong Kong, China.
| | | | | | | |
Collapse
|
24
|
Bourgeois JA, Hilty DM, Chang CH, Wineinger MA, Servis ME. Poststroke Neuropsychiatric Illness: An Integrated Approach to Diagnosis and Management. Curr Treat Options Neurol 2004; 6:403-420. [PMID: 15279761 DOI: 10.1007/s11940-996-0031-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Patients who have had stroke are at significant risk for various neuropsychiatric illnesses. The most common and important of these are poststroke depression and poststroke dementia (attributable to vascular dementia, Alzheimer's dementia, or a combination of mechanisms). Poststroke neuropathology may lead some patients to experience concurrent and "overlapping" mood and cognitive symptoms. Less frequently, poststroke anxiety disorders, psychosis, isolated pathologic expressions of emotions, and apathy or fatigue may be encountered. The authors review the current literature on poststroke neuropsychiatry and offer an integrated approach to pathophysiologic concepts and clinical surveillance, screening, diagnosis, and evidence-based pharmacologic and nonpharmacologic intervention for these clinical problems on the clinical boundary between neurology and psychiatry.
Collapse
Affiliation(s)
- James A. Bourgeois
- Department of Psychiatry and Behavioral Sciences Rehabilitation, University of California, Davis Medical Center, 2230 Stockton Boulevard, Sacramento, CA 95817, USA. james.bour
| | | | | | | | | |
Collapse
|
25
|
Affiliation(s)
- Steven G Sugden
- Department of Psychiatry, University of California, Davis, Sacramento, CA 95817, USA
| | | |
Collapse
|
26
|
Dobkin BH. Rehabilitation and Recovery of the Patient with Stroke. Stroke 2004. [DOI: 10.1016/b0-44-306600-0/50064-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
27
|
Van de Meent H, Geurts ACH, Van Limbeek J. Pharmacologic treatment of poststroke depression: a systematic review of the literature. Top Stroke Rehabil 2003; 10:79-92. [PMID: 12970833 DOI: 10.1310/b51g-29mp-25hq-arnh] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
UNLABELLED CLINICAL QUESTION/OBJECTIVE: A systematic evaluation of the literature published from 1966 until December 2001 on pharmacologic interventions for poststroke depression (PSD). DESIGN Articles were selected from a computer-based search and were independently reviewed by three evaluators using a standardized criteria including internal validity items as well as descriptive and quantitative items. RESULTS Fifty studies were preliminarily reviewed and 10 randomized controlled trials (RCTs) were included for systematic analysis. CONCLUSION Selective serotonin reuptake inhibitors (citalopram and fluoxetine) may be effective in the treatment of PSD. There is some evidence for a beneficial effect of the tricyclic antidepressant nortriptyline, however, the RCTs for this medication lack sufficient validity, and reports on side effects are contradictory.
Collapse
Affiliation(s)
- H Van de Meent
- University Medical Center, St Radboud Nijmegen, The Netherlands
| | | | | |
Collapse
|
28
|
Abstract
Depression is a common occurrence after stroke and is associated with excess disability, cognitive impairment, and mortality. The authors undertook a systematic review of the English language literature to review several aspects of this illness, including the prevalence of this disorder, the debate on its etiology, and the current understanding of the biological treatment of poststroke depression. Methodological problems encountered in the study of poststroke depression are highlighted throughout the manuscript. The authors conclude that the available evidence supports poststroke depression as being multifactorial in origin and consistent with the biopsychosocial model of mental illness.
Collapse
Affiliation(s)
- Ellen M Whyte
- Department of Psychiatry, University of Pittsburgh, Pennsylvania 15213, USA
| | | |
Collapse
|
29
|
Turner-Stokes L, Hassan N. Depression after stroke: a review of the evidence base to inform the development of an integrated care pathway. Part 2: Treatment alternatives. Clin Rehabil 2002; 16:248-60. [PMID: 12017512 DOI: 10.1191/0269215502cr488oa] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Depression is a common complication of stroke, leading to increased morbidity and mortality. It can impede the process of rehabilitation, and has been associated with poorer outcomes and increased length of stay in hospital. This systematic review was undertaken as a preliminary step to the development of an evidence-based integrated care pathway (ICP) for the management of post-stroke depression (PSD) in a rehabilitation setting, and is divided into two parts. In part 1 we reviewed the frequency of depression in stroke, its impact on functional recovery and the different methods for assessment. AIMS AND OBJECTIVES In part 2, we discuss the rationale for treatment of PSD, appraise the evidence for effectiveness of the different antidepressant drugs, and consider whether we can identify a recommended first-line treatment for use in our ICP. METHODS Data sources comprised a computer-aided search of published studies on depression in stroke and references to literature used in reviews. MAIN FINDINGS From the few controlled trials of anti-depressant therapy in PSD, both tricyclics and selective serotonin re-uptake inhibitors (SSRIs) appear to be effective, but the latter may be preferable in stroke because of their prompt action and better side-effect profiles. Within the group of SSRIs there is currently no direct evidence to guide the choice of agent. In the absence of firm guidance, sertraline was chosen on theoretical grounds as one of the most potent with minimal sedative effects and no reported interaction with warfarin. Citalopram may offer an appropriate second choice. CONCLUSIONS A suggested regimen for the use of sertraline in PSD was put forward. Development of an ICP may help to establish a more consistent approach to assessment and treatment of PSD, and form a basis for future comparison of different treatments as they become available.
Collapse
Affiliation(s)
- Lynne Turner-Stokes
- Regional Rehabilitation Unit, Northwick Park and St Mark's Hospital Trust, Harrow, Middlesex, UK.
| | | |
Collapse
|
30
|
Müller U. Pharmakotherapie emotionaler Störungen bei Patienten mit erworbener Hirnschädigung. ZEITSCHRIFT FUR NEUROPSYCHOLOGIE 2001. [DOI: 10.1024//1016-264x.12.4.336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung: Emotionale Störungen sind häufige und klinisch bedeutsame Folgeerscheinungen nach erworbener Hirnschädigung. In den letzten Jahren sind zahlreiche Original- und Übersichtsarbeiten zu epidemiologischen, pathophysiologischen und therapeutischen Aspekten neuro-psychiatrischer Störungen erschienen. Ausgehend von diagnostischen Überlegungen gibt die vorliegende Arbeit eine aktuelle Übersicht zur Pharmakotherapie von Depressionen, emotionaler Instabilität (pathologisches Weinen), organischer Manie (bipolarer Störung), Angststörungen und Antriebsstörungen (Apathie). Patienten mit Schlaganfall und traumatischer Hirnschädigung stehen im Mittelpunkt, so wie in der Forschungs- und Lehrbuch-Literatur. Psychische Störungen bei neurodegenerativen und systemischen Erkrankungen des Gehirns werden nur am Rande erwähnt. Ausführlich werden differentielle Indikationen und Nebenwirkungen neuartiger Antidepressiva diskutiert. Ausblickend werden innovative Therapiestrategien wie CRH-Antagonisten und die präventive Behandlung mit Antidepressiva vorgestellt.
Collapse
Affiliation(s)
- U. Müller
- Klinik und Poliklinik für Psychiatrie der Universität Leipzig, Max-Planck-Institut für neuropsychologische Forschung Leipzig, Leipzig
| |
Collapse
|
31
|
Cole MG, Elie LM, McCusker J, Bellavance F, Mansour A. Feasibility and effectiveness of treatments for post-stroke depression in elderly inpatients: systematic review. J Geriatr Psychiatry Neurol 2001; 14:37-41. [PMID: 11281315 DOI: 10.1177/089198870101400109] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To determine the feasibility and effectiveness of antidepressive treatments for post-stroke depression in elderly medical inpatients, MEDLINE was searched for potentially relevant articles published from January 1987 to August 1997 using the keywords "depression or depressive disorder" (exploded) and "aged." Thirteen reports met the following inclusion criteria: (1) published in English or French; (2) minimum age criterion of 55 and over or mean age 65 and over; (3) post-stroke subjects admitted to a medical, geriatric, or rehabilitation service; (4) used accepted criteria for depression; (5) examined treatment(s) for depression; and (6) reported outcomes as a depression diagnosis and/or symptom level. Data were abstracted independently from each article by two reviewers. The limited evidence suggests contraindications to treatment of 83% of a group to receive a heterocyclic antidepressant compared with 11% of a group to receive a selective serotonin reuptake inhibitor (SSRI); rates of discontinuation and study completion are similar for heterocyclics, SSRIs and psychostimulants. All of the treatments appear to be at least modestly effective in the short term.
Collapse
Affiliation(s)
- M G Cole
- Department of Psychiatry, St. Mary's Hospital and McGill University, Montreal, Quebec
| | | | | | | | | |
Collapse
|
32
|
Affiliation(s)
- Angela Gall
- Department of Rehabilitation Medicine, Woodend Hospital, Aberdeen AB15 6XS
| |
Collapse
|
33
|
Abstract
Depression following stroke is common. Although it is highlighted as an issue in stroke guidelines, guidance on diagnosis or management is not given. This paper presents the original research from a literature review of Medline and the Cochrane Database on stroke and depression, and discusses some of the clinical implications of the findings.
Collapse
Affiliation(s)
- A Gall
- Department of Rehabilitation Medicine, Woodend Hospital, Aberdeen AB15 6XS
| |
Collapse
|
34
|
Nakamura K, Shirane M, Koshikawa N. Site-specific activation of dopamine and serotonin transmission by aniracetam in the mesocorticolimbic pathway of rats. Brain Res 2001; 897:82-92. [PMID: 11282361 DOI: 10.1016/s0006-8993(01)02096-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The effects of aniracetam on extracellular levels of dopamine (DA), serotonin (5-HT) and their metabolites were examined in five brain regions in freely moving stroke-prone spontaneously hypertensive rats (SHRSP) using in vivo microdialysis. Basal DA release in SHRSP was uniformly lower in all regions tested than that in age-matched control Wistar Kyoto rats. 3,4-Dihydroxyphenylacetic acid and homovanillic acid levels were altered in the basolateral amygdala, dorsal hippocampus and prefrontal cortex of SHRSP. While basal 5-HT release decreased in the striatum and increased in the basolateral amygdala, there was no associated change in 5-hydroxyindoleacetic acid levels. Systemic administration of aniracetam to SHRSP enhanced both DA and 5-HT release with partly associated change in their metabolite levels in the prefrontal cortex, basolateral amygdala and dorsal hippocampus, but not in the striatum and nucleus accumbens shell, in a dose-dependent manner (30 and/or 100 mg/kg p.o.). Microinjection (1 and 10 ng) of aniracetam or its metabolites (N-anisoyl-GABA and 2-pyrrolidinone) into the nucleus accumbens shell produced no turning behavior. These findings indicate that SHRSP have a dopaminergic hypofunction throughout the brain and that aniracetam elicits a site-specific activation in mesocorticolimbic dopaminergic and serotonergic pathways in SHRSP, possibly via nicotinic acetylcholine receptors in the ventral tegmental area and raphe nuclei. The physiological roles in the aniracetam-sensitive brain regions may closely link with their clinical efficacy towards emotional disturbances appearing after cerebral infarction.
Collapse
Affiliation(s)
- K Nakamura
- CNS Supporting Laboratory, Nippon Roche Research Center, 200 Kajiwara, Kamakura, 247-8530, Kanagawa, Japan.
| | | | | |
Collapse
|
35
|
|
36
|
Abstract
Methylphenidate is a commonly used medication in the United States. This central nervous system stimulant has a mechanism of action distinct from that of amphetamine. The Food and Drug Administration has approved methylphenidate for the treatment of attention-deficit/hyperactivity disorder and narcolepsy. Treatment with methylphenidate has been advocated in patients with traumatic brain injury and stroke, cancer patients, and those with human immunodeficiency virus infection. Placebo-controlled trials have documented its efficacy as an adjunctive agent in the treatment of depression and pain. This article reviews the current understanding of the mechanism of action and efficacy of methylphenidate in various clinical conditions.
Collapse
Affiliation(s)
- T D Challman
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | |
Collapse
|
37
|
|
38
|
Goldstein LB. Effects of amphetamines and small related molecules on recovery after stroke in animals and man. Neuropharmacology 2000; 39:852-9. [PMID: 10699450 DOI: 10.1016/s0028-3908(99)00249-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Drugs modulating the levels of specific central neurotransmitters may influence both the rate and amount of functional recovery after focal brain injuries such as stroke. Because such drugs may be effective long after brain injury, the "therapeutic window" may be widened beyond the first few hour after stroke and an entirely new avenue for pharmacological intervention may be possible. The impact of drugs affecting norepinephrine and gamma-aminobutyric acid have been among the most extensively studied in the laboratory, and preliminary clinical data suggest similar effects in humans.
Collapse
Affiliation(s)
- L B Goldstein
- Box 3651, Duke University Medical Center, Durham, NC 27710, USA.
| |
Collapse
|
39
|
|
40
|
|
41
|
Gillen R, Eberhardt TL, Tennen H, Affleck G, Groszmann Y. Screening for depression in stroke: Relationship to rehabilitation efficiency. J Stroke Cerebrovasc Dis 1999; 8:300-6. [PMID: 17895179 DOI: 10.1016/s1052-3057(99)80004-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/1998] [Accepted: 01/22/1999] [Indexed: 11/24/2022] Open
Abstract
Depression is common after stroke but is often not diagnosed. Its presence may impair progress during rehabilitation and limit functional improvement after discharge. We investigated the use of the Geriatric Depression Scale (GDS) to screen for depression among acute stroke patients. All stroke patients in an acute rehabilitation hospital who were referred for assessment of cognitive deficits were also screened for depression with the GDS. By using a modified cutoff score to account for items that could reflect physical effects of the stroke rather than depression, 22% of patients screened were classified as depressed. The rate of depression was higher among women (36%) than men (10%). Patients with elevated GDS scores (> or =15) stayed in the hospital an average of 5.76 days longer than patients whose scores fell below this cut-off. Higher GDS scores were also associated with less efficient use of rehabilitation services as measured by the Functional Independence Measure. Screening stroke patients for depression at the time of admission to rehabilitation may identify individuals at risk to progress more slowly, may initiate more comprehensive assessment, and, if appropriate, may initiate rapid intervention.
Collapse
Affiliation(s)
- R Gillen
- Sunnyview Hospital and Rehabilitation Center, Schenectady, NY USA
| | | | | | | | | |
Collapse
|
42
|
Black-Schaffer RM, Kirsteins AE, Harvey RL. Stroke rehabilitation. 2. Co-morbidities and complications. Arch Phys Med Rehabil 1999; 80:S8-16. [PMID: 10326898 DOI: 10.1016/s0003-9993(99)90096-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This self-directed learning module highlights new advances in the understanding of co-morbid conditions and medical complications of stroke. It is part of the chapter on stroke rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article covers co-morbid conditions of stroke patients, including cardiovascular disease, diabetes, and sleep apnea. It reviews recent information on complications of stroke, including deep venous thrombosis, dysphagia and aspiration, hospital-acquired infections, depression, falls, spasticity, shoulder pain, and seizures. Treatment advances in diabetes, depression, and spasticity are highlighted. Recent information is presented regarding exercise guidelines for the stroke patient with cardiovascular disease, the relationship between stroke and sleep apnea, prophylaxis of deep venous thrombosis, the changing spectrum of hospital-acquired infections, malnutrition in stroke patients, the problem of falls during rehabilitation, the evaluation and management of poststroke shoulder pain, and the risk of seizures after stroke.
Collapse
|
43
|
|
44
|
Nyenhuis DL, Gorelick PB. Vascular dementia: a contemporary review of epidemiology, diagnosis, prevention, and treatment. J Am Geriatr Soc 1998; 46:1437-48. [PMID: 9809769 DOI: 10.1111/j.1532-5415.1998.tb06015.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The past decade has seen a renewed interest in vascular dementia. Key epidemiologic studies have examined the prevalence, incidence, course and risk factors of vascular dementia. New classification systems have been developed to improve the reliability of the diagnosis, and there have been advances in diagnostic methodology, such as neuroimaging and neuropsychological assessment. New treatments for vascular dementia are being developed to protect the brain from cerebral ischemia and to limit progression of cognitive impairment. Diagnostic criteria for vascular dementia remain to be validated by carefully designed, systematic, clinicopathologic study. Once such criteria are validated, meaningful study of subgroups of vascular dementia can be explored. Until the relationship between vascular dementia and Alzheimer's disease is better defined, the nosology for vascular dementia may be defined best as dementia associated with stroke.
Collapse
Affiliation(s)
- D L Nyenhuis
- Center for Stroke Research, Department of Neurological Sciences, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA
| | | |
Collapse
|
45
|
Plutchik L, Snyder S, Drooker M, Chodoff L, Sheiner P. Methylphenidate in post liver transplant patients. PSYCHOSOMATICS 1998; 39:118-23. [PMID: 9584537 DOI: 10.1016/s0033-3182(98)71358-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Methylphenidate (Ritalin, manufacturer: Ciba/Geigy) has been shown effective for the treatment of depression in various medically ill populations, but to our knowledge its use in organ transplant patients has not been described. The authors retrospectively reviewed clinical records of the first eight inpatients who received methylphenidate for treatment of depressive and/or cognitive symptoms in the post liver transplant period at Mount Sinai Medical Center. Target symptoms included psychomotor and cognitive slowing as well as lack of motivation for recovery, poor rehabilitation effort, social withdrawal, and apathy. A positive response was noted in seven patients, and in one patient the response was equivocal. Side effects noted were increased blood pressure (N = 2) and subjective restlessness/agitation (N = 3). Methylphenidate appears to be an effective, rapidly acting agent in this setting at dosages of 10-20 mg/day, with minimal side effects. Methylphenidate may have a significant role in the care of an ever-increasing population of organ transplant recipients with multiple medical problems and associated disabilities.
Collapse
Affiliation(s)
- L Plutchik
- Beth Israel Medical Center, New York, NY 10003, USA
| | | | | | | | | |
Collapse
|
46
|
|
47
|
Abstract
OBJECTIVE To examine literature on poststroke depression (PSD). DATA SOURCES More than 200 articles related to stroke and depression were selected from a computer-based search spanning 1985 to 1995. STUDY SELECTION All relevant articles on PSD. Articles in foreign languages, case studies, anecdotal reports, book chapters, and reviews were excluded. DATA EXTRACTION Summary findings were independently reviewed by the authors. DATA SYNTHESIS PSD remains a frequent sequela of stroke; its prevalence remains uncertain because of continued methodologic problems in defining subject groupings and in utilizing psychiatrically normed assessment tools with neurologically impaired individuals, and because of the poor specificity/sensitivity of neuroendocrine markers in determining a diagnosis. The etiology of PSD appears to be complex and not fully understood. Although there has been much research on PSD, this review highlights the sparsity of available literature on its treatment. CONCLUSION The review points out the further need for more carefully designed studies of PSD that examine both assessment and treatment.
Collapse
Affiliation(s)
- W A Gordon
- Department of Rehabilitation Medicine, Mount Sinai Medical Center, New York, NY 10029, USA
| | | |
Collapse
|
48
|
Hosking SG, Marsh NV, Friedman PJ. Poststroke depression: prevalence, course, and associated factors. Neuropsychol Rev 1996; 6:107-33. [PMID: 9104740 DOI: 10.1007/bf01874894] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Despite the considerable amount of research that has been undertaken on poststroke depression, a review of the literature demonstrates that there are many inconclusive findings in the area. In particular, the causes and course of the disorder remain to be firmly established. While studies of prevalence differ with respect to the nature and timing of their assessment procedures, most conclude that poststroke depression has a negative impact on the rehabilitation of the stroke patient. Very little research is available on te relationship between poststroke depression and care-giver burden. However, recent studies have adopted more rigorous methodological procedures, allowing some insights into the complex mixture of factors which determine the occurrence of poststroke depression.
Collapse
Affiliation(s)
- S G Hosking
- Department of Psychology, University of Waikato, Hamilton, New Zealand
| | | | | |
Collapse
|
49
|
Hanks RA, Lichtenberg PA. Physical, psychological, and social outcomes in geriatric rehabilitation patients. Arch Phys Med Rehabil 1996; 77:783-92. [PMID: 8702372 DOI: 10.1016/s0003-9993(96)90257-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Previous research studies that addressed the relationship between age and functional outcome had limited generalizability because of small sample size, lack of an urban population, and limited variables that do not allow for a complete investigation of social, cognitive, psychological, and medical factors in geriatric rehabilitation. The present study attempted to assess the relationship between decade of geriatric life (60s, 70s, 80s, and 90+) and functional outcome. DESIGN Survey study of geriatric cohorts. SETTING Inpatient university-affiliated rehabilitation hospital. PATIENTS 812 urban geriatric rehabilitation patients divided into four groups based on decade of life. MAIN OUTCOME MEASURES Index of comorbid disease, principal diagnoses, Functional Independence Measure, Mattis Dementia Rating Scale, Geriatric Depression Scale, CAGE alcohol questionnaire, and residential status at admittance and discharge. RESULTS Although there were no significant demographic differences between groups (apart from age), there were differences in functional outcome suggesting that the younger old (60s and 70s) and the older old (80s and 90+) patients may represent two different rehabilitation groups. CONCLUSIONS The younger old patients showed significantly higher alcohol abuse and comorbid physical disease, while the older-old patients demonstrated significantly poorer cognitive skills and more dependent social status on discharge from the rehabilitation facility. Despite the younger group's physical problems and alcohol use, they demonstrated better physical recovery. Implications for working with these two groups of urban geriatric patients in a rehabilitation setting are discussed.
Collapse
Affiliation(s)
- R A Hanks
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | | |
Collapse
|
50
|
Emptage RE, Semla TP. Depression in the medically ill elderly: a focus on methylphenidate. Ann Pharmacother 1996; 30:151-7. [PMID: 8835049 DOI: 10.1177/106002809603000209] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To describe depression in the medically ill elderly and discuss methylphenidate as a treatment option. DATA SOURCES A MEDLINE search from 1986 to 1995 was done to identify the literature published on depression in the medically ill as well as the literature on the use of methylphenidate for depression in the medically ill elderly. The references of articles found were evaluated for other relevant articles. STUDY SELECTION Retrospective and prospective studies that evaluated the use of methylphenidate in depressed, medically ill elderly were reviewed. DATA EXTRACTION Information on depression in the medically ill elderly was abstracted from original and review articles on the subject. The information pertaining to methylphenidate came from clinical studies. CONCLUSIONS Depression in the medically ill elderly occurs frequently and is underdetected in part because of the difficulty in diagnosing depression in this population. Methylphenidate has been found to be a safe and effective treatment of depression in the medically ill elderly. A potential advantage of methylphenidate over other antidepressants is its relatively quick onset of action, usually within 2-5 days. Older patients whose depressive symptoms are interfering with their functional capabilities or participation in prescribed therapies to improve or restore function after a medical illness should be considered for a trial of methylphenidate.
Collapse
Affiliation(s)
- R E Emptage
- Department of Pharmacy Practice, University of Illinois at Chicago, USA
| | | |
Collapse
|