Diagnosis, phenomenology and treatment of poststroke depression

Abstract

Diagnosing depression in stroke patients is a challenge in neuropsychiatry since depression symptoms may overlap neurological deficit signs. The best approach is to assess the presence of depressive symptoms using semi-structured or structured psychiatric interviews, such as the Present State Exam, the Structured Clinical Interview for DSM-IV or the Schedules for Clinical Assessment in Neuropsychiatry. The diagnosis of a depressive syndrome should be made according to standardized diagnostic criteria for mood disorders due to neurological disease such as in the DSM-IV or ICD-10. Depression rating scales such as the Hamilton Depression Scale and the Center for Epidemiologic Scales for Depression may be used to rate the depression severity and monitor the progression of antidepressant treatment. Most studies have reported the effectiveness of pharmacological treatment in patients with post-stroke depression, and there is preliminary evidence that the degree of impairment in activities of daily living (ADL) may improve as well.

Depressão pós-AVC: fatores de risco e terapêutica antidepressiva

“…Vários estudos têm mostrado uma boa eficácia da terapêutica antidepressiva 48 . A nortriptilina mostrou ser superior ao placebo e à fluoxetina quanto à remissão da sintomatologia depressiva e tolerância, de acordo com estudo duplo cego randomizado realizado por Robinson et al 49 e, superior ao placebo de acordo com Kimura et al 22 .…”

Importance of retardation and fatigue/interest domains for the diagnosis of major depressive episode after stroke: a four months prospective study

“…5 Thus, early recognition and management of depression have been considered as critical for functional improvement after stroke. 6,7 However, detection of depression after stroke is bellow 20-50%. 8 Although several factors may contribute to such under-detection, the first step to improve the diagnosis of depression is to recognize the most specific symptoms.…”