Antidepressant may offer hope for stroke victims

It's probably not too reassuring to learn that scientists don't really understand how antidepressants work. Despite their almost ubiquitous presence in television advertisements and doctor's offices, the drugs remain a cipher, with researchers still unsure whether they work by simply altering concentrations of the neurotransmitters that influence communication between brain cells or by some type of long-term change in the brain.

One popular theory, for instance, is that antidepressants induce neurogenesis, or the growth of new brain cells; this is why, the argument goes, the drugs need two to four weeks to take effect. So far, the evidence for this theory has been inconclusive and even contradictory; studies have shown that antidepressants do seem to lead to neurogenesis but also that this seems irrelevant to their effectiveness, which may have to do more with changes in connections between brain regions.

But there is a benefit to drugs that remain somewhat mysterious—they sometimes end up offering unexpected but useful treatments for seemingly unrelated conditions. A new study, has found that the antidepressant escitalopram seems to help stroke victims recover more of their cognitive function than other treatments.

The study, conducted by Ricardo Jorge and his colleagues at the University of Iowa, Iowa City, involved 129 people treated within three months of their strokes. After 12 weeks of therapy, the 43 patients given escitalopram showed better overall scores on tests of thinking, learning, and visual and verbal memory than 45 patients taking a placebo pill and 41 participating in a problem-solving therapy program designed for patients with depression. Many people who have strokes become depressed after their attack, but further analysis of the data showed that the benefits of the antidepressant were independent of its effect on depression symptoms; it was doing something beyond simply treating depression.

The findings are particularly promising, since they offer treatment options for nearly all newly diagnosed stroke victims. Many other cutting-edge stroke therapies in testing or research can prevent much of the damage from occurring in the first place, but only if applied within a few hours of the stroke. Escitalopram offers hope for modest improvements even for the many people who miss that crucial window. According to the researchers, the drug also was effective regardless of the type of stroke suffered.

The situation is likely to come full circle: Just as the Iowa researchers speculate that structural brain changes attributed to antidepressants may contribute to the stroke recovery, scientists studying drug function may one day point to the stroke results to support their theories about antidepressants. If the stroke findings make anything clear, it's that the debate over the drugs is far from over—and that that's not necessarily a bad thing.

—Aalok Mehta

PTSD in Haiti: Expert warns on post-quake mental health

With efforts in Haiti currently focusing on basic necessities and medical emergencies, the stage is set for a mental health epidemic. Lack of food, water, shelter and medical attention has left little time and effort for grieving or for psychological treatment. David Spiegel, a psychiatry professor at Stanford University, researches post-traumatic stress disorder and in a recent interview shed some light on what we should expect in the coming months in Haiti.

Half of the Haitian population will eventually show some signs of PTSD or depression, expects Spiegel, who has received brain and immuno-imaging grant funding from the Dana Foundation in the past. Witnessing deaths or severe injuries, as well as dealing with disease, hunger, dehydration and violence, are all stressors that lead to PTSD, he points out. The loss of a daily routine that included loved ones, friends, work and school, along with a lack of identification or proper burial for many quake casualties, can contribute to the onset of depression.

Symptoms of PTSD typically begin no less than a month after a trauma, Spiegel says. That means that there is still time for emotional support and organized mental health relief. The National Center for Posttraumatic Stress Disorder lists cognitive and exposure therapy, medication, eye movement desensitization and reprocessing, and counseling as some potential treatments for PTSD.  According to news reports, thousands of volunteers have shown up in Haiti on their own without clear direction or organization. Although these people have shown compassion to grieving children and adults and are doing their best to offer emotional support, they are not the mental health professionals that many Haitians currently need.

Spiegel points out that after the Sept. 11, 2001, attacks in New York and Virginia, trauma symptoms resolved pretty quickly because of an abundance of resources offering emotional and social support to onlookers and victims. The situation in Haiti, on the other hand, more closely resembles the aftermath of Hurricane Katrina, in which a delayed response by the government increased feelings of despondency and desperation. “I expect plenty of that in Haiti,” Spiegel says, “since the government has all but evaporated.”

-Angie Marin

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