According to new Canadian research, many stroke patients are being prescribed antidepressants without a proper diagnosis, suggesting that some patients are being over-treated while others are getting overlooked.
“A lot of people are being treated for depression, but we don’t know if they’re the right ones,” said lead researcher Katherine Salter of Parkwood Hospital in London, Ontario.
“This study found that 40 percent of stroke patients were treated for depression, but most were not screened or diagnosed. Who are we treating?”
Depression is the most common mental health condition after a stroke, affecting more than a one-fourth of all stroke patients. Depression may get in the way of a patient’s ability to participate in post-stroke therapy and is linked to slower rehabilitation and a longer stay in the hospital.
For the study, researchers looked at the medical charts of 294 patients discharged from five in-patient rehabilitation programs over a six-month period. Only three of 294 patients given an antidepressant were formally screened, assessed and diagnosed with depression first.
The findings also showed that 40 percent of all patients, whether or not they were screened or assessed for depression, received treatment for it.
Furthermore, 100 percent of patients who had already been taking an antidepressant when they entered in-patient rehabilitation still received one at the time of their discharge, mostly without being reassessed.
“No matter what the best practice recommendations say, if you’re on an antidepressant when you show up, you will not likely be screened or assessed, but you will be given more drugs,” said Salter.
A lack of formal screening and assessment for depression means that stroke patients without a history of depression or other mental illness could be overlooked for treatment.
According to the findings, patients with a history of mental illness and those with severe impairments from their stroke are more likely to be given antidepressants.
“Depression is a serious problem for people with stroke. We need to make sure that everyone who needs treatment for depression is receiving the right help,” said neurologist Dr. Michael Hill, Co-Chair of the Canadian Stroke Congress.
According to Salter, a lack of access to mental health care professionals, as well as “some inertia” by clinicians reluctant to change their methodology, may be the reason that patients are not being screened properly.
“We need to be able to include psychological resources as part of our health care team. These professionals should be a central, integrated part of recovery,” said Salter.
Ian Joiner, the director of stroke for the Heart and Stroke Foundation said, “Screening for depression after all strokes could result in more positive outcomes for patients and their families. With screening, those who would benefit from specialized medication, counseling and referral to other health professionals won’t be missed.”
The study was presented on October 1 at the Canadian Stroke Congress.