Mohammed T. Abou-Saleh

426 PRINCIPLES AND PRACTICE OF GERIATRIC PSYCHIATRYpsychiatric nurse had lower rates of depression 6 and 12 monthsafter stroke than those in the treatment-as-usual group, and lowerscores on a measure of psychological distress at 12 months. Thisfinding is encouraging, since it shows that a brief, structuredpsychological intervention is beneficial to patients after stroke,albeit in a sample selected to participate in a clinical trial. Thereare disadvantages to psychological management: it may bedifficult to implement in patients with significant speech andcognitive impairment 38 , and some patients find psychologicaltreatments unacceptable, both before and after the treatment hasstarted.In summary, depression after stroke is common, and its causesare probably multiple—biological, psychological and social—as isthe case in other physical illnesses. The evidence for benefit fromantidepressant drugs is surprisingly poor, considering theirproblematic side effects and how widely they are prescribed. Thepotential for psychological therapies has been underevaluated,which is a deficit that badly needs correcting. Pending furtherresearch, clinicians will need to rely on evidence from other areasof physical medicine to inform their treatments.REFERENCES1. Kotila M, Numminen H, Waltimo O, Kaste M. Depression afterstroke: results of the FINSTROKE Study. Stroke 1998; 29: 368–72.2. Pohjasvaara T, Leppavuori A, Siira I et al. Frequency and clinicaldeterminants of poststroke depression. Stroke 1998; 29: 2311–17.3. House A, Dennis M, Mogridge L. Mood disorders in the year afterfirst stroke. Br J Psychiat 1991; 158: 83–92.4. Wade DT, Legh-Smith J, Hewer RA. Depressed mood after stroke. Acommunity study of its frequency. Br J Psychiat 1987; 151: 200–205.5. Morris PL, Robinson RG, Samuels J. Depression, introversion andmortality following stroke. 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