Ecosystem Focused Therapy in Post Stroke Depression



Status:Completed
Conditions:Depression, Neurology
Therapuetic Areas:Neurology, Psychiatry / Psychology
Healthy:No
Age Range:50 - Any
Updated:2/8/2019
Start Date:March 2012
End Date:January 31, 2019

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Older adults who are stroke survivors can experience many challenges, including depression,
cognitive dysfunction, and physical disability. Family members and other caregivers may
struggle with helping stroke survivors adjust to life after stroke. This research study
involves testing a modified form of problem-solving therapy called Ecosystem Focused Therapy
(EFT) to help treat depression in older adult stroke survivors. EFT teaches problem-solving
skills to patients to help them cope with problems related to stroke and depression, alters
their physical environment to accommodate new needs resulting from stroke, and helps the
family or caregiver to assist in the patient's adaptation. In addition this study will
compare EFT to an education intervention to see which is more effective in treating depressed
stroke survivors.

We propose to study the efficacy of "Ecosystem Focused Therapy" (EFT) in post-stroke
depression (PSD), a disorder that afflicts a large number of stroke victims and increases
mortality, cognitive impairment, and disability for years after stroke. EFT is a new,
home-delivered intervention based on our integrative model of PSD, which originated from our
clinical biology and treatment studies in late-life depression. It postulates two main paths
to PSD. First, stroke and stroke-repair mechanisms contribute to metabolic changes mediating
PSD. Second, a "psychosocial storm" stemming both from the patient's sudden disability and
the change in the patient's needs and family life add a biological burden to this cascade of
depressogenic events. EFT targets the "psychosocial storm" of PSD and focuses on the
reciprocal interaction between the patient's abilities and the challenges of his/her
"ecosystem" (family, specialized therapists). EFT follows a structured personalization
approach based on the "model of adaptive functioning", in which behavior is a function of the
person's competence and the demands of the environment. Thus, EFT continuously "calibrates
the environment" to the PSD patient's competence level and targets the PSD "psychosocial
storm" through five integrated components: 1) It offers an action-oriented, "new perspective"
about the patient's recovery. 2) It provides an "adherence enhancement structure". 3) It
offers a "problem solving structure" to the patient focusing on problems, valued by the
patient, and pertinent to daily function. 4) It helps the family "reengineer its goals,
involvement, and plans" to accommodate the patient's disability. 5) It "coordinates care with
specialized therapists" with the goal to increase patient participation in rehabilitation and
social activities.

Inclusion Criteria:

1. Age 50 years and older;

2. Diagnosis of unipolar major depression;

3. Montgomery Asberg Depression Rating Scale score ≥ 18;

4. Capacity to provide written consent for both research assessment and treatment;

5. Command of English sufficient to participate in assessments and talking therapy.

Exclusion Criteria:

1. Moderately severe to severe dementia (MMSE score < 20);

2. Greater than mild to moderate aphasia (NIH Stroke Scale: Best Language > 1);

3. Expectation to be discharged to a nursing home;

4. Psychotic depression;

5. Suicidal intent or plan.
We found this trial at
3
sites
White Plains, New York 10605
Principal Investigator: George S. Alexopoulos, M.D.
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White Plains, NY
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New York, New York 10032
Principal Investigator: Michael O'Dell, M.D.
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from
New York, NY
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White Plains, New York 10605
Principal Investigator: Michael Redding, M.D.
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White Plains, NY
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