Antidepressant treatment duration and poststroke survival

Feng H, Jia H, Cowper Ripley DC, Wang X, Wu SS, Shorr RI, Ried LD. Antidepressant treatment duration and poststroke survival. Paper presented at: VA HSR&D National Meeting; 2011 Feb 17; National Harbor, MD.

Post-stroke antidepressant treatment has improved patients' survival over 5-year post stroke. However, the impact of minimum accumulative antidepressant dosage on post-stroke mortality is unknown. We investigated the relationship between antidepressant administration duration and post-stroke survival. In this retrospective study, we indentified all VISN-8 stroke patients in fiscal year 2001 through chart review from VA medical SAS databases, and obtained patients' antidepressant dispensing information from VA pharmacy benefits management database. Time to death was calculated from stroke onset date to the end of the study with maximum 2465 follow-up days. Based on their Serotonin Selective Reuptake Inhibitor (SSRI) dispensing status, patients were categorized into four groups (A. None; B. 6-month pre-stroke; C. 12-month post-stroke; and D. Both pre- and post-stroke). Kaplan-Meier survival analysis and Cox proportional hazards regression were applied to examine SSRI dispensing effects on stroke survival adjusting for patient demographics, comorbidities, and depression diagnosis. Among the 790 patients, SSRI dispensing time post-stroke ranged from 0 to > 3 months. Product limit estimates showed that the five-year survival rates were 65% for group A, 31% for group B, 60% for group C, and 55% for group D. Group B patients had the lowest survival rate (31%, log-rank test p = 0.002). Results from the non-time dependent Cox proportional hazards regression confirmed the Kaplan-Meier survival estimation. However, the time dependent Cox proportional hazards model accounting for the effect of subjects changing the SSRI dispensing status one-year post-stroke showed that the group D had a significantly lower mortality risk (P Poststroke SSRI treatment adherence by stroke patients helps improve their survival, and it may also help to improve their functional recovery and health-related quality of life. Further study is warranted in examining the minimum accumulative SSRI dosage and divergence on SSRI dispensing individually and geographically.