News Director: Maureen Shawn Kennedy, MA, RN
E-mail: shawn.kennedy@wolterskluwer.com
Nurse-Led Interventions Decrease Depression in Stroke Survivors
Combined with antidepressant therapy, they’re demonstrating success.
D
epression is a common
sequela of stroke, and
antidepressant therapy
has been shown to be helpful in
mitigating its effects in stroke sur-
vivors, although its long-term
usefulness is in doubt. According
to a recent study, antidepressant
therapy by itself wasn’t nearly as
successful as when it was combined
with a brief nurse-led intervention.
Patients receiving nine sessions of
a psychosocial–behavioral ther-
apy intervention over eight weeks,
plus antidepressant medication
as needed, reported significantly
lower scores on the Hamilton Rat-
ing Scale for Depression (HRSD)
than did a group receiving usual
care (information on poststroke
depression plus antidepressants
as indicated), both right after com-
pletion of the intervention (at
nine weeks) and a year into the
study.
Almost half (47%) of the 44 pa-
tients in the intervention group
went into remission (according
to the HRSD score) directly after
counseling, compared with 19% in
the 48-person usual-care group, a
correlation that held up 12 months
later (48% versus 27%, respec-
tively). (The uneven numbers
reflect the dwindling of the orig-
inal, randomized group of 101,
because of illness or death or be-
cause patients dropped out of the
study.)
Called Living Well with Stroke,
the intervention was adapted from
a talk therapy intervention used in
dementia patients; the nine ses-
sions include exercises that help
the patients explore what is pleas-
urable to them. As “homework,”
the stroke survivors schedule
ajn@wolterskluwer.com
pleasant activities. “The inter-
vention itself is practical and
concrete,” says lead author Pamela
Mitchell, professor and associate
dean for research in the School
of Nursing at the University of
Washington in Seattle.
Mitchell and her team are now
developing a study to compare
the in-person intervention with
one performed over the telephone.
“There’s a growing focus on
making these kinds of transitions
from acute care to life in the com-
munity,” she says, “and this is
something that could be very eco-
nomically incorporated into a dis-
charge plan.”
Mary Pinzon, stroke educa- have lost your job, your dreams,
tion nurse at the James R. Daniel and that’s a pretty good formula
Stroke Center in Oklahoma City, for depression. Interventions
agrees: “In the future, we’re going like this can provide a connec-
to have to be more creative with tion, and that’s invaluable.”
what we do. She adds, “There’s a —Bunny Wong
tendency to become isolated after
you’ve had a stroke. You may Mitchell PH, et al. Stroke 2009;40(9):3073-8.
NewsCAP
NewsCAP
!Treating children with common antiviral drugs for influenza con-
fers few benefits, according to a report in the August 10 issue of
BMJ. A metaanalysis of seven studies involving children younger
than age 12 concludes that the antivirals oseltamivir (Tamiflu)
and zanamivir (Relenza) shorten the duration of flu symptoms by
only a half a day to a day and a half and do little to prevent
complications such as asthma exacerbations or ear infections.
Nor do they significantly lower the rate of antibiotic administra-
tion. Tamiflu also may cause vomiting in a small number of pedi-
atric patients. Some studies included children infected with type
A influenza, although none involved the pandemic (H1N1) 2009
(swine flu) strain, leading the authors to write, “It is difficult to know
the extent to which these findings can be generalized to children
in the current pandemic.”
AJN ▼ November 2009 ▼ Vol. 109, No. 11 19