Poststroke Depression Does Not Decrease Women's Compliance With Medications

Kathleen Louden

April 18, 2008

April 18, 2008 (Chicago, Illinois) — After a stroke, women are more likely to become depressed and have poorer quality of life than men, but depressed men are more likely to stop taking their stroke-prevention medications, a new study found.

"It's important to recognize that women are more likely to be depressed and to have poor quality of life after a stroke," lead author Cheryl Bushnell, MD, associate professor of neurology at Wake Forest University School of Medicine, in Winston-Salem, NC, said in an interview with Medscape Neurology & Neurosurgery. "But we've been focusing on women recently, and I don't think we fully understand what's happening in men. If they're deciding they don't need their medications, that's a problem."

Although physicians do not currently treat men and women differently after a stroke, Dr. Bushnell said, "Maybe we should."

She presented the results here at the American Academy of Neurology 60th Annual Meeting.

Adherence and Outcomes

Depression after an ischemic stroke or transient ischemic attack (TIA) was reported by 20% of women and 8.2% of men who participated in the Adherence Evaluation After Ischemic Stroke — Longitudinal (AVAIL) registry. This initiative involves more than 100 US hospitals participating in the American Heart Association's Get With the Guidelines — Stroke program.

The objective of this preliminary study was to measure, in 491 patients, whether sex modifies the effect of depression and quality of life on adherence to taking antithrombotic, antihypertensive, and lipid-lowering medications as prescribed at hospital discharge. The authors defined adherence as self-reported continued use of all 3 classes of medications, determined by a telephone questionnaire 3 months after discharge.

"Past research shows, if [stroke-prevention] medications aren't adhered to as prescribed, outcomes are worse," said Dr. Bushnell.

Sex Affects Adherence

In their study, the overall adherence to poststroke medical treatment was 78%, which Dr. Bushnell called "quite good."

The bad news, however, was that men who were more depressed than others, as indicated by higher scores on the Patient Health Questionnaire-8 (PHQ-8), had lower adherence to their medication schedule, Dr. Bushnell said.

Among study patients, the median PHQ-8 score of 5 for women represented mild depression, but men's median score of 4 did not meet the criteria for even mild depression, Dr. Bushnell said during her presentation. Yet despite being more depressed, women were still more likely to take their medications.

Likewise, quality of life, as measured with the EuroQoL-5D (EQ5D) scale, was poorer in women who adhered to their medication schedule than in adherent men (0.73 vs 0.81, respectively), the study found.

It appears that neither poststroke depression nor quality of life has an impact on women's motivation to take their medications, Dr. Bushnell concluded.

In response to a question from the audience, Dr. Bushnell said that women were less likely than men to have someone helping them with their medications. "But despite that, they were more adherent," she said.

The study authors have not yet analyzed the data on patients' antidepressant use, she added.

Another factor that Dr. Bushnell and her colleagues found to decrease adherence to taking medications was visual deficit caused by the stroke. "I've not seen this finding in the literature before," she told the audience.

Many Factors to Nonadherence

Mark Alberts, MD, 1 of the moderators of the Cerebrovascular Prevention session where Dr. Bushnell presented and a professor of neurology at Chicago's Northwestern University, in Illinois, told Medscape Neurology & Neurosurgery, "The issue of adherence to medications is very important. We have many medications now for preventing stroke, but often patients don't take them."

Dr. Alberts added, "From my experience, there are many factors for nonadherence. We need to look further at adherence and lack thereof and how to improve it."

The study was supported by research funding from the Bristol-Myers Squibb/Sanofi-Aventis Partnership. Dr. Bushnell had no financial disclosures. Dr. Alberts reports no relevant financial disclosure.

American Academy of Neurology 60th Annual Meeting: Abstract S24.001. Presented April 16, 2008.


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