Brief Psychosocial-Behavioral Intervention With Antidepressant Reduces Poststroke Depression Significantly More Than Usual Care With Antidepressant Living Well With Stroke: Randomized, Controlled Trial

Background and Purpose-Depression after stroke is prevalent, diminishing recovery and quality of life. Brief behavioral intervention, adjunctive to antidepressant therapy, has not been well evaluated for long-term efficacy in those with poststroke depression. Methods-One hundred one clinically depressed patients with ischemic stroke within 4 months of index stroke were randomly assigned to an 8-week brief psychosocial-behavioral intervention plus antidepressant or usual care, including antidepressant. The primary end point was reduction in depressive symptom severity at 12 months after entry. Results-Hamilton Rating Scale for Depression raw score in the intervention group was significantly lower immediately posttreatment (P < 0.001) and at 12 months (P = 0.05) compared with control subjects. Remission ( Hamilton Rating Scale for Depression <10) was significantly greater immediately posttreatment and at 12 months in the intervention group compared with the usual care control. The mean percent decrease (47%+/- 26% intervention versus 32%+/- 36% control, P = 0.02) and the mean absolute decrease (-9.2 +/- 5.7 intervention versus -6.2 +/- 6.4 control, P = 0.023) in Hamilton Rating Scale for Depression at 12 months were clinically important and statistically significant in the intervention group compared with control. Conclusion-A brief psychosocial - behavioral intervention is highly effective in reducing depression in both the short and long term. ( Stroke. 2009; 40:3073-3078.)