Management of depression in elderly stroke patients

Abstract

Poststroke depression (PSD) in elderly patients has been considered the most common neuropsychiatric consequence of stroke up to 6–24 months after stroke onset. When depression appears within days after stroke onset, it is likely to remit, whereas depression at 3 months is likely to be sustained for 1 year. One of the major problems posed by elderly stroke patients is how to identify and optimally manage PSD. This review provides insight to identification and management of depression in elderly stroke patients. Depression following stroke is less likely to include dysphoria and more likely characterized by vegetative signs and symptoms compared with other forms of late-life depression, and clinicians should rely more on nonsomatic symptoms rather than somatic symptoms. Evaluation and diagnosis of depression among elderly stroke patients are more complex due to vague symptoms of depression, overlapping signs and symptoms of stroke and depression, lack of properly trained health care personnel, and insufficient assessment tools for proper diagnosis. Major goals of treatment are to reduce depressive symptoms, improve mood and quality of life, and reduce the risk of medical complications including relapse. Antidepressants (ADs) are generally not indicated in mild forms because the balance of benefit and risk is not satisfactory in elderly stroke patients. Selective serotonin reuptake inhibitors are the first choice of PSD treatment in elderly patients due to their lower potential for drug interaction and side effects, which are more common with tricyclic ADs. Recently, stimulant medications have emerged as promising new therapeutic interventions for PSD and are now the subject of rigorous clinical trials. Cognitive behavioral therapy can also be useful, and electroconvulsive therapy is available for patients with severe refractory PSD.

Post-Stroke Depression

“…Наиболее патогенетически оправданным является назначение антидепрессантов, что доказано во многих плацебо-контролируемых исследованиях [6,7]. Исполь-зование антидепрессантов может улучшить не только эмоциональное состояние, но и когнитивные функции, привести к более быстрому и существенному восстанов-лению утраченных неврологических функций, улучить качество жизни [7,8].…”

“…Исполь-зование антидепрессантов может улучшить не только эмоциональное состояние, но и когнитивные функции, привести к более быстрому и существенному восстанов-лению утраченных неврологических функций, улучить качество жизни [7,8].…”

Pharmacological and Psychotherapeutic Interventions for Management of Post-stroke Depression: A Bayesian Network Meta-analysis of 27 Randomized Controlled Trials

“…Antidepressants are most studied strategies and the best studied agents are citalopram, nortriptyline, fluoxetine, and sertraline. [12] Major goals of PSD treatments include reducing depressive symptoms and getting complete remission (no longer meeting baseline criteria for depression). [13] Meta-analysis found antidepressants to be significantly effective in reducing depressive symptoms.…”

“…[13,14] However, there is no clear evidence to recommend antidepressants in terms of getting complete remission of depression when assessed by Diagnostic and Statistical Manual of Mental Disorders (DSM) or Hamilton Depression Rating Scale (HAMD). [13,15] Although selective serotonin reuptake inhibitors (SSRIs) are gaining popular as 1st-line treatment for PSD and late-life depression, [12] but no study provides conclusive evidence on the superiority of SSRIs over any other treatments, nor strong data recommending 1 particular SSRI over another for PSD management.…”

Interventions for management of post-stroke depression: A bayesian network meta-analysis of 23 randomized controlled trials

“…Furthermore, Hackett et al found no superiority over control intervention for psychotherapy alone 13 . Although selective serotonin reuptake inhibitors (SSRIs) are gaining popularity as first-line treatment for PSD and late-life depression 12,16 , neither studies provide conclusive evidence with respect to the superiority of SSRIs over any other treatments nor strong data recommend one particular SSRI over another for PSD management.…”