Pathophysiology and Current Drug Treatments for Post-Stroke Depression: A Review

Abstract

Post-stroke depression (PSD) is a biopsychosocial disorder that affects individuals who have suffered a stroke at any point. PSD has a 20 to 60 percent reported prevalence among stroke survivors. Its effects are usually adverse, can lead to disability, and may increase mortality if not managed or treated early. PSD is linked to several other medical conditions, including anxiety, hyper-locomotor activity, and poor functional recovery. Despite significant awareness of its adverse impacts, understanding the pathogenesis of PSD has proved challenging. The exact pathophysiology of PSD is unknown, yet its complexity has been definitively shown, involving mechanisms such as dysfunction of monoamine, the glutamatergic systems, the gut-brain axis, and neuroinflammation. The current effectiveness of PSD treatment is about 30–40 percent of all cases. In this review, we examined different pathophysiological mechanisms and current pharmacological and non-pharmacological approaches for the treatment of PSD.

Reliability of the Montreal Cognitive Assessment in people with stroke

“…This may be a possible explanation for the six outliers with more prominent improvement in the retest measurement. For the outliers below the lower limit of the 95% LOA mean difference, the participants might have been complicated with poststroke sequelae such as depression [30], which may have affected their cognitive performance during the reassessment.…”

Psychiatric comorbidities in adults with sickle cell disease: A narrative review

“…[54][55][56] Stroke is also commonly associated with depression, with one review finding between 20% and 60% of patients having post-stroke depression, 57 which commonly presents in the first 3 months after CVA. 58 Serotonin-reuptake inhibitors (SSRIs) are recommended as post-stroke treatment to improve mood, help patients endure physical therapy and to promote cerebrovascular blood flow. 57 In neuroimaging studies, SCD has correlated with changes in frontal lobe and basal ganglia volumes, with basal ganglia and thalamic volumes correlating with lower nonverbal IQ, perceptual organization and working memory.…”

Co-occurrence of depression and chronic diseases

“…Głównymi lekami stosowanymi w tym przypadku są SSRI (najkorzystniejsze są citalopram i escitalopram), które oddziaływać mogą w sposób plejotropowy na mózg chorego po udarzewykazują działanie neuroprotekcyjne i stymulację neurogenezy; dodatkowo poprawiają regulację przepływu krwi dzięki zwiększeniu stężenia monoamin, przez co ograniczają obszar martwych neuronów w ognisku udaru. Innymi lekami o dużej skuteczności są SNRI -wenlafaksyna, duloksetyna, milnacipran, NDRI -bupropion, MAOI -selegilina, izokarboksazyd, fenelzyna [55]. Depresja w przebiegu cukrzycy stanowi duży problem terapeutyczny ze względu na gorsze stosowanie się do zaleceń lekarskich dotyczących zmian w stylu życia, stosowania diety cukrzycowej, aktywności fizycznej oraz zdrowotny ze względu na zwiększenie ryzyka zgonu; dlatego niezbędne jest skuteczne leczenie współistniejącej depresji.…”