Psychosocial/Behavioral Intervention in PSD

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DESCRIPTION (provided by applicant): In March 2002, this study was funded as a randomized controlled trial to test the efficacy of a nurse- delivered brief psychosocial-behavioral intervention on depression and subsequent activity and participation outcomes in stroke survivors who are clinically depressed (1R01NR007755-01A1). The fourth aim of this study is to explore patient characteristics that are most predictive of response to this intervention. This aim was included because of the conflicting literature regarding predictors of post-stroke depression and the almost complete absence of evidence regarding who is most likely to benefit from either drug or nonpharmacologic therapies in PSD. Recent evidence regarding the value of genetic polymorphisms of the SERT gene in predicting both depression and response to SSRI has prompted us to add this characteristic to those already proposed (gender, major or minor depression, severity of stroke, or level of social support, all factors associated with depression in the literature). This supplemental project capitalizes on a continuing collaboration between biobehavioral investigators in the Department of Biobehavioral Nursing & Health Systems and Ruth Kohen, MD. Dr. Kohen is currently conducting an NIH grant to study 5-HT receptors and SERT polymorphisms in an animal model of depression. Early findings in that supplemental study point to the value of the SERT polymorphisms in predicting depression concomitant with a chronic condition and the response of that depression to psychosocial interventions. Thus, this supplement will provide the opportunity to add a new marker that may ultimately have value in terms of predicting responses to drug and non-drug therapies in patients with post-stroke depression (and possibly depression concomitant with other chronic health problems). In addition, the data will provide important descriptive information that could be used to further explore, albeit indirectly, the role of serotonin in post-stroke depression.