Use of psychotropic drugs in the very old and their relation to stroke and depression

Background: Depression is frequently found after stroke, but depression seems to be also a risk factor for stroke incidence in the elderly. The use of psychotropic drugs in the elderly is common, but only few information is available about depression and stroke and their impact on the use of psychotropic drugs.

Methods: A representative sample of 494 85-year-olds in Gothenburg, Sweden was examined with psychiatric examinations and key-informant interviews. Diagnoses of depression and dementia were made according to the DSM-III-R. Information on stroke was obtained from hospital linkage system, death certificates, self-reports and key-informants. The sample was followed for three years regarding the incidence of stroke. Those with dementia at baseline were excluded from all analyses and those with previous stroke were excluded from the incidence study. Information of the use of psychotropic drugs was obtained from all participants.

Findings: Sadness (adjusted RR 2.3, 95%-CI 1.3–4.3) and decreased appetite (RR 2.0, 95%-CI 1.1–3.9) in non-demented 85-year-olds were associated with an increased incidence of first-ever stroke during the follow-up period. Stroke history at age 85 was associated with use of antidepressants (OR 3.0, 95%-CI 1.0–8.8), but not with depression at age 85. Depression at age 85 was associated with a high use of anxiolytics/sedatives, but neither antidepressive treatment with tricyclic antidepressants nor anxiolytic sedatives were associated with stroke incidence.

Interpretation: Depression and stroke are both common in this segment of the population. It has to be elucidated whether depression treatment with modern antidepressants might be effective in the prevention of stroke.