Depression is a common sequela of stroke, and antidepressant therapy has been shown to be helpful in mitigating its effects in stroke survivors, although its long-term usefulness is in doubt. According to a recent study, antidepressant therapy by itself wasn't nearly as successful as when it was combined with a-brief nurse-led intervention. Patients receiving nine sessions of a psychosocial-behavioral therapy intervention over eight weeks, plus antidepressant medication as needed, reported significantly lower scores on the Hamilton Rating Scale for Depression (HRSD) than did a group receiving usual care (information on poststroke depression plus antidepressants as indicated), both right after completion of the intervention (at nine weeks) and a year into the study.

Almost half (47%) of the 44 patients in the intervention group went into remission (according to the HRSD score) directly after counseling, compared with 19% in the 48-person usual-care group, a correlation that held up 12 months later (48% versus 27%, respectively). (The uneven numbers reflect the dwindling of the original, randomized group of 101, because of illness or death or because patients dropped out of the study.)

Called Living Well with Stroke, the intervention was adapted from a talk therapy intervention used in dementia patients; the nine sessions include exercises that help the patients explore what is pleasurable to them. As "homework," the stroke survivors schedule pleasant activities. "The intervention itself is practical and concrete," says lead author Pamela Mitchell, professor and associate dean for research in the School of Nursing at the University of Washington in Seattle.

Mitchell and her team are now developing a study to compare the in-person intervention with one performed over the telephone. "There's a growing focus on making these kinds of transitions from acute care to life in the community," she says, "and this is something that could be very economically incorporated into a discharge plan."

Mary Pinzon, stroke education nurse at the James R. Daniel Stroke Center in Oklahoma City, agrees: "In the future, we're going to have to be more creative with what we do. She adds, "There's a tendency to become isolated after you've had a stroke. You may have lost your job, your dreams, and that's a pretty good formula for depression. Interventions like this can provide a connection, and that's invaluable."

Bunny Wong