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Introduction: Post-stroke depression affects one in three stroke patients and is associated with increased mortality and disability. Physical activity (PA) has been associated with fewer depressive symptoms after stroke, however, the long-term effect of pre-stroke PA and how Selective Serotonin Reuptake Inhibitors may affect this association is unknown. Methods: The study was conducted as a secondary analysis of data from The Efficacy of Citalopram Treatment in Acute Ischemic Stroke (TALOS) trial, where consecutive non-depressed acute ischemic stroke patients were randomized to Citalopram 20 mg or placebo for 6 months. Pre-stroke PA was measured using the Physical Activity Scale for the Elderly (PASE) and dichotomized by overall median value. Depressive symptoms were measured using the Major Depression Inventory (MDI) at one and six months after stroke. We used multivariable linear regression models to evaluate the interaction of pre-stroke PASE score and post-stroke MDI score. Results: We included 543 patients with complete PASE and MDI data at one month. Of these, 257 (47.3%) were in the SSRI group, 75% were men, and median (interquartile range) age was 69 (60 to 77). Overall, high PASE score was associated with lower MDI scores both one month (mean difference [confidence interval (CI)] -2.02 [-3.28 to -0.75]) and six months (-1.71 [-3.21 to -0.2]) after stroke. At one-month, a high PASE score was associated with lower MDI scores in the placebo group (mean difference -2.14 [-3.74 to -0.54]). After six months, an association between high pre-stroke PASE and lower MDI score was only found in the Citalopram group (mean difference -1.71 [-3.21 to -0.2]). Among patients with high pre-stroke PASE score the Citalopram group had lower MDI scores than the placebo group at six months (mean diff 2.01 [0.25 to 3.77]). Conclusions: High pre-stroke PA was independently associated with fewer depressive symptoms one and six months after stroke, however at six months the association was only present among those treated with Citalopram, suggesting an effect modification by Citalopram on the effect of PA on depressive symptoms. Further trials are warranted to verify these results.

Background and Purpose: We investigated the association between adherence to the EAT-Lancet diet, a sustainable and mostly plant-based diet, and risk of stroke and subtypes of stroke in a Danish population. For comparison, we also investigated the Alternate Healthy Eating Index-2010 (AHEI). Methods: We used the Danish Diet, Cancer and Health cohort (n=55 016) including adults aged 50 to 64 years at baseline (1993–1997). A food frequency questionnaire was used to assess dietary intake and group participants according to adherence to the diets. Stroke cases were identified using a national registry and subsequently validated by review of medical records (n=2253). Cox proportional hazards models were used to estimate hazard ratios and 95% CIs for associations with the EAT-Lancet diet or the AHEI and risk of stroke and stroke subtypes. Results: Adherence to the EAT-Lancet diet was associated with a lower risk of stroke, although not statistically significant (highest versus lowest adherence: hazard ratio, 0.91 [95% CI, 0.76–1.09]). A lower risk was observed for AHEI (0.75 [95% CI, 0.64–0.87]). For stroke subtypes, we found that adherence to the EAT-Lancet diet was associated with a lower risk of subarachnoid hemorrhage (0.30 [95% CI, 0.12–0.73]), and the AHEI was associated with a lower risk of ischemic stroke (0.76 [95% CI, 0.64–0.90]) and intracerebral hemorrhage (0.58 [95% CI, 0.36–0.93]). Conclusions: Adherence to the EAT-Lancet diet in midlife was associated with a lower risk of subarachnoid stroke, and the AHEI was associated with a lower risk of total stroke, mainly ischemic stroke and intracerebral hemorrhage.

Objective: To examine incidence, predictors and mortality related to antidepressant treatment after ischemic stroke in a clinical setting. Methods: Patients were identified from the Danish Stroke Registry which holds information on antidepressant treatment due to post stroke depression (PSD) and pathological crying (PC) from 2003-2010. Treatment initiation and mortality were analyzed using Kaplan-Meier curves and Cox regression. Potential predictors of antidepressant treatment were identified using multiple logistic regression. Results: Among 5070 first ever stroke patients without prior antidepressant treatment, 32.5% were treated with antidepressants within six months after stroke, primarily with selective serotonin reuptake inhibitors. Approximately half of the treated patients started treatment during stroke admission (mean time after stroke: 7 days for PC and 10 days for PSD). The vast majority of treated patients started treatment within 90 days (86%). Among patients treated during admission 93.1% redeemed at least one prescription after discharge. The predictor most strongly associated with treatment was stroke severity. The adjusted hazard ratio of death was 0.39 (95% CI: 0.31-0.48) for treated patients as compared to non-treated patients. Conclusion: Antidepressant treatment after stroke was common and often initiated early. Although increasing stroke severity was a strong predictor of antidepressant treatment, treatment was associated with a lower mortality.

Introduction: SSRIs are widely used for treating post-stroke depression and pathological crying and appear to have antithrombotic effects that may increase the risk of bleeding. Increasing evidence further suggests a neuroprotective effect in stroke, however clinical data are sparse. Aim and hypothesis: We aimed to examine the implications of pre-admission SSRI use in patients with ischemic and hemorrhagic stroke. We hypothesized a neuroprotective and antithrombotic effect leading to less severe strokes and decreased 30-day mortality among the ischemic strokes, and a possible reverse effect among the hemorrhagic strokes. Methods: We did a nationwide registry-based follow-up study among ischemic and hemorrhagic stroke patients in Denmark between 2003 and 2011. We identified 4348 pre-admission SSRI users (556 hemorrhagic strokes) and 4348 propensity score-matched non-users in the Danish Stroke Registry. Multiple conditional logistic regression was used to compute odds ratios (OR) of severe stroke (as measured on the Scandinavian Stroke Scale) and death within 30 days after stroke. Analyses were repeated after excluding patients with hemorrhagic stroke. Results: For the stroke types combined, pre-admission SSRI use was associated with a higher risk of severe stroke (adjusted OR, 1.12; CI, 1.00-1.25) and a non-significantly higher risk of death within 30 days (adjusted OR, 1.27; CI, 0.73-2.19). In contrast, no statistically significant difference in risk of severe stroke (adjusted OR, 1.06; CI, 0.92-1.21) or death within 30 days (adjusted OR, 0.81; CI, 0.38-1.77) was found between pre-admission SSRI-users and non-users after excluding patients with hemorrhagic stroke. Conclusion: Our results suggest that pre-admission SSRI use may be associated with a higher risk of severe stroke and case-fatality in patients with hemorrhagic stroke, but not in patients with ischemic stroke. Further studies are warranted to explore the possible neuroprotective and hemorrhagic effects of SSRI treatment in patients admitted with acute stroke.