Physicians are prescribing antidepressants for many stroke patients without first giving them a proper diagnosis — a trend that is resulting in the unnecessary over-treatment of some patients while others are being overlooked.
That’s the chief finding of a new study presented at the Canadian Stroke Congress this month by Ontario researchers.
"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?"
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Depression is common following stroke, affecting more than a quarter of all stroke patients. It may affect a patient's recovery, limit his or her ability to participate in post-stroke therapy and can slow progress during rehabilitation.
But the new study suggests that reality is leading many doctors to over-prescribe depression drugs for many patients.
Researchers examined medical charts for 294 patients discharged from five in-patient rehabilitation programs in southwestern Ontario over a six-month period beginning in September 2010. Only three of the patients given an antidepressant were formally screened, assessed and diagnosed with depression first. But 40 percent of all patients received treatment for depression.
Researchers also found that all of the patients who were taking an antidepressant at the time of their admission to in-patient rehabilitation still received one at the time of their discharge, 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.
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At the same time, the 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.
"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.