national-clinical-guidelines-for-stroke-fourth-edition

National clinical guideline for stroke
Evidence to recommendations
Psychological interventions and drug treatments may be helpful in treating depression
and anxiety after stroke, but there is no evidence to determine the choice of drug
treatment (Campbell Burton et al 2011; Hackett et al 2008b). Brief psychological
interventions, such as motivational interviewing (see section 6.18) or problem-solving
therapy, may be helpful in the prevention and treatment of depression after stroke.
Evidence for some recommendations is stroke-specific and based on systematic reviews
of trials; other recommendations are at consensus level due to a lack of evidence.
Research is needed into psychological interventions, in particular for anxiety after stroke.
6.35.1 Recommendations
A Any patient considered to have depression or anxiety should be assessed for other
mood disorders.
B Patients with mild or moderate symptoms of depression should be given information,
support and advice (see recommendation 6.34.1G) and considered for one or more of
the following interventions:
● increased social interaction
● increased exercise
● goal setting
● other psychosocial interventions.
C Patients prescribed antidepressant drug treatment for depression or anxiety should be
monitored for known adverse effects, and treatment continued for at least 4 months
beyond initial recovery. If the patient’s mood has not improved 2–4 weeks after
initiating treatment, check that the patient is taking the medicine as prescribed. If
they are, then consider increasing the dose or changing to another antidepressant.
D Patients receiving drug treatment for depression or anxiety should have it reviewed
regularly to assess continued need.
E Brief, structured psychological therapy should be considered for patients with
depression. Therapy will need to be adapted for use in those with neurological
conditions.
F Antidepressant treatment should not be used routinely to prevent the onset of
depression.
6.35.2 Sources
A–C Consensus
D Hackett et al 2008a; Hackett et al 2008b; Mitchell et al 2009; National Institute for
Health and Clinical Excellence 2009a
E National Institute for Health and Clinical Excellence 2009a; Pinquart and
Duberstein 2007; Wolitzky et al 2008; Cicerone et al 2008; Mitchell et al 2009;
Watkins et al 2011
F Hackett et al 2008a
114 © Royal College of Physicians 2012