Depression after stroke is common, but associated risk factors and mortality are still poorly understood. Jørgensen and colleagues studied a register-based Danish cohort of individuals with a first hospitalization for stroke. In total, 25% of patients with stroke and 8% in the reference population experienced depression within 2 years after hospitalization. Incidence of depression was especially high in the first 3 months after stroke. In both populations, individuals with depression had increased all-cause mortality. In an editorial, Anderson discusses the importance of this large epidemiological study of depression after stroke.
Depression is common following traumatic brain injury, but we do not know how to prevent this complication. Jorge and colleagues randomized 94 participants with new traumatic brain injury to sertraline 100 mg daily or placebo for 24 weeks or until development of a mood disorder and found that sertraline was significantly more effective in reducing depression onset; adverse effects were mid in both study groups. These results suggest that sertraline is effective in preventing the onset of depression following traumatic brain injury.
Prediction of suicidal behavior is of great clinical value. Oquendo and colleagues used positron emission tomography to study serotonin receptor 5-HT1A and serotonin transporter binding in 100 patients presenting for treatment of a major depressive episode. Over 2 years, 15 patients made suicide attempts including 2 who died by suicide. Higher 5-HT1A binding potential in raphe nuclei predicted more suicidal ideation and more lethal suicidal behavior.
Medications to treat alcohol dependence are available, but their effectiveness is modest. Moderators of response include hedonic response to sweet taste, which reflects activity of the μ-opioid system and high baseline craving. In a randomized trial of naltrexone and placebo, Garbutt and colleagues found that sweet-liking phenotype and high level of craving were associated with a strong response to naltrexone. In contrast, patients without the sweet-liking phenotype or high level of craving did not have a significant response to naltrexone.
Suicide is a leading cause of death yet remains difficult to predict. McCoy and colleagues used natural language processing of narrative discharge notes from 2 large academic medical centers to improve stratification of risk for death by suicide after hospital discharge. There were 235 deaths by suicide during 2.4 million patient-years of follow-up. Words conveying positive emotion in the narrative notes was associated with a 30% reduction in risk for suicide.
In This Issue . JAMA Psychiatry. 2016;73(10):. doi:10.1001/jamapsychiatry.2015.1654