Summary

Researchers have speculated that particular lesions caused by stroke can predispose patients to depression. To learn more about a possible association between depression and stroke, these researchers compared the incidence of depression over one year in 190 patients suffering a first cerebral infarct (mean age, 69; 47% female) with the incidence of depression in 200 patients suffering a first myocardial infarct (MI; mean age, 60; 23% female).

Participants were consecutive emergency-room patients with stroke or MI. Those with prior depression, other current psychiatric disorders, dementia, aphasia, or general frailty were excluded. Standardized rating scales were used to determine depression incidence.

Cumulative one-year incidence of depression was found to be 39% in stroke patients and 28% in MI patients (P=0.06). This difference, however, disappeared when the researchers controlled for sex, age, and level of handicap. In approximately half of the depressed patients in each group, depression developed during the first month after stroke or MI.
Comment

These results raise questions about the specificity of stroke - or of particular stroke-associated lesions - as a cause of depression. Still, stroke and MI share many vascular risk factors (e.g., hypertension, increased serum cholesterol, and diabetes); it remains possible that the high rate of depression in both conditions represents a common cerebrovascular mechanism. The depression in both conditions could also signify a general stress-precipitated reaction.

- Gary Tucker, MD

Journal Watch 2(7), 2003. © 2003 Massachusetts Medical Society