Vascular risk factors for stroke and depression

Stewart et al (2001) present an important study of the association between the vascular risk factors for stroke and depression. Although the non-participation rates and levels of physical morbidity were high in the sample, they did not find any association between risk factors for vascular disease and level of depression in the older adult population (aged 55-75 years) studied. We have prospectively studied 45 stroke patients (aged 26 to 65 years) for psychiatric morbidity. The most common disorder was depression (in 78% of the patients), followed by generalised disorder (in 17%). Younger age, physical disability (resulting in occupational and social dysfunction) and past history of stroke were strongly correlated with depression. Vascular disease has been found to be associated with a more prolonged duration of depression (Hickie & Scott, 1998), but in our sample 52% of the patients with depression recovered within 3-6 months of treatment. However, two patients who were unemployed when they were disabled by stroke did have depression of prolonged duration. Uncontrolled hypertension (moderate to severe) was associated with the presence of generalised anxiety disorder. The role of medication (especially beta-blockers, calcium channel blockers and sedatives) in producing depression is an important variable and could not be ruled out in six patients. Although laterality of brain lesion (i.e. left hemispheric lesion) and risk of depression have been reported (Robinson & Price, 1982), the subject remains controversial and we did not find any such association. A detailed prospective study on a larger sample of patients from all age groups and different socio-demographic backgrounds is needed to establish the association of depression with various demographic and vascular risk factors for stroke.