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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Williams Carlos Williams was a physician and a poet. He suffered from multiple episodes of major depression, and had post-stroke depressions in later life; yet, he remained a productive writer until a few years prior before his death, at age 80. The structure, style, and content of Williams' writings evolved continually, and he received a Pulitzer Prize posthumously for poetry written during his later life. The authors discuss factors that seem to be associated with his successful coping with mental illness. Williams' life helps challenge the negative stereotypes associated with serious mental illness and aging.
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PMID:William Carlos Williams. 1501 Mar 41

First-ever stroke patients (n=20) with a DSM-IV diagnosis of major depressive disorder (MDD) were included in an open-label study and received a single oral dose (50-100 mg) of the selective serotonin reuptake inhibitor sertraline. At days 0, 7, 14, 28, 42, and 56, a psychometric test battery comprising the Hamilton rating scales for depression and anxiety, the Mini Mental State Examination and the Barthel Index was administered. At the endpoint, 9 (45%) of the subjects were no longer depressed, 4 (20%) presented minor depression, and 7 (35%) still suffered from MDD. Considering the whole group of treated patients, depression and anxiety symptoms were found to decrease continuously and cognitive and functional performances to improve continuously during the treatment. Furthermore, differences between the values recorded by the treatment responders and non responders at the end of follow up were highly significant (p<0.02 for all comparisons). This report suggests that sertraline treatment of post-stroke MDD could be effective and well tolerated. However, non responders to the treatment are at risk of poor outcome. Double blind studies with a greater number of patients are necessary to confirm these preliminary results.
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PMID:Sertraline treatment of post-stroke major depression: an open study in patients with moderate to severe symptoms. 1505 48

A major factor in evaluating and treating depression is the presence of comorbid medical problems. In this paper, the authors will first evaluate studies showing that medical illness is a risk factor for depression. The authors will review a series of randomized, controlled studies of antidepressant treatment in subjects with major depressive disorder (MDD) and comorbid medical illnesses (myocardial infarction, stroke, diabetes, cancer, and rheumatoid arthritis). Most of these studies report an advantage for an active antidepressant over placebo in improvement of depressive symptoms. The authors also will review a series of studies in which the outcome of antidepressant treatment is compared between subjects with MDD with and without comorbid medical illness. In these studies, subjects with medical illness tend to have lower improvement of depressive symptoms and higher rates of depressive relapse with antidepressant treatment compared with MDD subjects with no medical comorbidity. In addition, the authors will review hypotheses on the mechanism of the interaction between medical illness and clinical response in MDD. The paper will conclude that medical comorbidity is a predictor of treatment resistance in MDD.
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PMID:Impact of medical comorbid disease on antidepressant treatment of major depressive disorder. 1514 72

Major depressive disorder is frequently undiagnosed and untreated in older patients. Grief, pain, sleep issues, concurrent medications, altered physiology, and the presence of comorbid medical and psychiatric conditions can complicate the management of depression in older patients. Remission should be the goal of therapy in treating depression in the elderly, just as it is in younger patients, to maximize the impact of treatment on quality of life. Managing depression in older patients can be done effectively with the antidepressant therapies currently available, including selective serotonin reuptake inhibitors (SSRIs), venlafaxine, and mirtazapine. Comorbid medical conditions, which are common among older patients, can have a significant impact on depression and vice versa. Antidepressant therapy with SSRIs has demonstrated efficacy and tolerability in patients at high risk for cardiovascular events and stroke and in those with vascular dementia or Alzheimer's disease. Care should be taken to choose antidepressants with no or minimal effects on glucose levels in patients with diabetes. In addition, venlafaxine has demonstrated beneficial effects on the relief of the pain of diabetic neuropathy. Venlafaxine, mirtrazapine, and the SSRIs have demonstrated efficacy and tolerability in older patients, while tricyclic antidepressants have also demonstrated efficacy; however, tolerability can be a problem. Depression is not a natural part of the aging process, as some still believe. The review of current data indicates that the goal of management can and should be full remission. Further, the use of newer agents is safe and effective in this population, as long as one considers the pharmacokinetics and pharmacodynamic properties and inherent biological differences in the elderly population when selecting appropriate therapy.
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PMID:Special issues in the management of depression in older patients. 1514 35

Major depressive disorder (MDD) in the elderly, children, and patients with unstable angina or acute myocardial infarction (MI) is a serious disorder. In elderly patients, where major depression is often overlooked and may have a significant impact on the quality of life, the goal of therapy is full remission. Selective serotonin reuptake inhibitors (SSRIs) have the most favorable combination of efficacy and side-effect profile for the elderly with MDD, regardless of the presence of medical comorbidities. Although the dual agent venlafaxine has been proposed as an alternative agent for older patients who are either nonresponders or partial responders to SSRIs, the frail elderly may be particularly vulnerable to its side effects. Most elderly patients have a relapse of depression when antidepressants are stopped; depression subsides when antidepressants are resumed. Because recent evidence suggests that the dosage of an antidepressant that achieves remission in the elderly does not always protect against recurrence, in addition to long-term maintenance, consideration should be given to increased dosage. Patients with major depression and either unstable angina or acute MI should be identified and considered for antidepressant treatment. Findings from the recent Sertraline Anti-Depressant Heart Attack Randomized Trial suggest that SSRIs may have antiplatelet and endothelium-protective properties that may benefit patients with depression and comorbid coronary artery disease and ischemic stroke. Concern regarding the safety of SSRIs in children has prompted new studies. Evidence suggests that the risks of SSRIs, except for fluoxetine, might outweigh benefits in the treatment of depression in children and adolescents.
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PMID:Recent developments in antidepressant therapy in special populations. 1535 75

In the last decade, multiple investigator groups have identified structural changes of various neuroanatomic structures in patients with idiopathic major depression and bipolar disorders. Using high-resolution MRI of the brain and functional neuroimaging studies (i.e., PET, SPECT), researchers have described decreases in the volume of hippocampal formation, amygdala, entorhinal cortex, various frontal lobe structures, and basal ganglia, in addition to abnormal cerebral blood flow and metabolic activity in these structures as well as in thalamic nuclei. Similar structural and functional changes have been identified in patients with depression associated with a variety of neurologic disorders (i.e., stroke, Parkinson's disease, epilepsy, Alzheimer's dementia). In addition, recent data have shown that depression is a risk factor for the development of several neurologic disorders, including epilepsy, stroke, and Parkinson's disease and bears a negative impact on the course and outcome of most neurologic disorders. This article reviews these data and provides evidence that major depressive and bipolar disorders may in fact be neurologic disorders with psychiatric symptoms.
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PMID:Is major depression a neurologic disorder with psychiatric symptoms? 1538 Jan 13

Mental fatigue, with decreased concentration capacity, is common in neuroinflammatory and neurodegenerative diseases, often appearing prior to other major mental or physical neurological symptoms. Mental fatigue also makes rehabilitation more difficult after a stroke, brain trauma, meningitis or encephalitis. As increased levels of proinflammatory cytokines are reported in these disorders, we wanted to explore whether or not proinflammatory cytokines could induce mental fatigue, and if so, by what mechanisms.It is well known that proinflammatory cytokines are increased in major depression, "sickness behavior" and sleep deprivation, which are all disorders associated with mental fatigue. Furthermore, an influence by specific proinflammatory cytokines, such as interleukin (IL)-1, on learning and memory capacities has been observed in several experimental systems. As glutamate signaling is crucial for information intake and processing within the brain, and due to the pivotal role for glutamate in brain metabolism, dynamic alterations in glutamate transmission could be of pathophysiological importance in mental fatigue. Based on this literature and observations from our own laboratory and others on the role of astroglial cells in the fine-tuning of glutamate neurotransmission we present the hypothesis that the proinflammatory cytokines tumor necrosis factor-alpha, IL-1beta and IL-6 could be involved in the pathophysiology of mental fatigue through their ability to attenuate the astroglial clearance of extracellular glutamate, their disintegration of the blood brain barrier, and effects on astroglial metabolism and metabolic supply for the neurons, thereby attenuating glutamate transmission. To test whether our hypothesis is valid or not, brain imaging techniques should be applied with the ability to register, over time and with increasing cognitive loading, the extracellular concentrations of glutamate and potassium (K+) in humans suffering from mental fatigue. At present, this is not possible for technical reasons. Therefore, more knowledge of neuronal-glial signaling in in vitro systems and animal experiments is important.In summary, we provide a hypothetic explanation for a general neurobiological mechanism, at the cellular level, behind one of our most common symptoms during neuroinflammation and other long-term disorders of brain function. Understanding pathophysiological mechanisms of mental fatigue could result in better treatment.
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PMID:On the potential role of glutamate transport in mental fatigue. 1552 5

Human neurodevelopment is the result of genetic and environmental interactions. This paper examines the role of prenatal nutrition relative to psychiatric disorders and explores the relationship among nutrients, mood changes, and mood disorders. Epidemiologic studies have found that adults who were born with a normal, yet low birth weight have an increased susceptibility to diseases such as coronary heart disease, diabetes, and stroke in adulthood. Prenatal caloric malnutrition, low birth weight, and prematurity also increase the risk for neurodevelopmental disorders, schizophrenia, affective disorders, and schizoid and antisocial personality disorders. Placebo-controlled studies in medicated patients suggest that add-on treatment with omega-3 fatty acids, particularly eicosapentaenoic acid, may ameliorate symptoms of major depressive disorder. Additional studies are necessary to confirm any benefits for bipolar disorders.
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PMID:Nutrients, neurodevelopment, and mood. 1553 90

This study attempted to evaluate the psychosocial, clinical, and radiological predictors of poststroke depression (PSD) in Chinese patients. One hundred eighty-nine patients participated in the study. Three months after the index stroke, a psychiatrist administered the Structured Clinical Interview for DSM-IV to all of the patients and made a DSM-IV diagnosis of depression. In addition, a host of demographic, clinical, and radiological variables were examined. Thirty-one (16.4%) of the patients had a diagnosis of PSD that included major depression (n=11, 5.8%,), minor depression (n=16, 8.5%), or dysthymia (n=4, 2.1%). Univariate analysis revealed that PSD was associated with female gender, a lower level of education, a lower Lubben Social Network Scale (LSNS) score, subcortical infarcts, and lesions in the anterior cerebral artery (ACA) territory, and the Modified Life Event Scale (MLES) score was borderline for statistical significance. Multivariate logistic regression analysis suggested that female gender, a high MLES score, and subcortical and ACA lesions were independent risk factors for PSD and that a high LSNS score was a protective factor.
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PMID:Poststroke depression in Chinese patients: frequency, psychosocial, clinical, and radiological determinants. 1568 28

Major depressive disorder (MDD) is a highly prevalent disease, frequently characterized by recurrent or chronic course, and by comorbidity with other medical illnesses. The lifetime prevalence of MDD ranges up to 17% in the general population, and it almost doubles in patients with diabetes (9-27%), stroke (22-50%), or cancer (18-39%). Moreover, MDD worsens the prognosis, quality of life, and treatment compliance of patients with comorbid medical illnesses. Similar to what is observed with other comorbid illnesses, MDD worsens the outcome of kidney disease patients by increasing both morbidity and mortality. Treatment of depressive symptoms in renal failure patients increases medication acceptability and therefore potentially improves the overall patient outcome. The issue of the safety of antidepressant treatment in subjects with renal failure is frequently counterbalanced by the risks associated with depression comorbidity, provided that antidepressants with a low volume of distribution and low protein binding are prescribed, and most important, at low initial doses. Screening for CYP isoenzyme interactions with current medications is also recommended before starting antidepressant treatment.
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PMID:Depression and renal disease. 1577 49


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