Post-Stroke Depression: A Review

Abstract

Objective-To review the world's (English-language) publications related to depression following stroke.Method-The databases from MEDLINE and PubMed were reviewed for articles related to poststroke depression (PSD), depression and cerebral vascular accident, depression and cerebral vascular disease, and depression and cerebral infarction.Results-Most studies examined prevalence rates of depression and the clinical correlates of depression. Based on pooled data, the overall prevalence of major depression was 21.7% and minor depression was 19.5%. The strongest single correlate of depression was severity of impairment in activities of daily living. However, the existence of depression at baseline was found to be associated with greater impairment at follow-up, ranging from 6 weeks to 2 years in 83% of studies. Further, depression following acute stroke was also associated with greater cognitive impairment and increased mortality. PSD has been shown in 6 double-blind controlled studies to be effectively treated with antidepressants, and 1 study has recently shown that PSD can be effectively prevented.Conclusions-During the past 20 years, significant progress has been made in the identification and treatment of depression following stroke. In the future, antidepressant treatment will likely play an increasing role in the management of patients with acute stroke. Further research is needed to identify the mechanisms of depression and why antidepressants lead to improved physical and cognitive recovery and decreased mortality.Keywords poststroke depression; stroke-related impairments; prevalence; diagnosis; mortality; mechanism of depression The group of cerebrovascular diseases, which includes both sudden-onset ischemia of the brain, owing to thrombosis or emboli and hemorrhagic bleeds within the brain parenchyma or subdural or epidural regions, usually owing to aneurysms or trauma, constitute some of the most common life-threatening problems among the elderly population. Stroke, defined as a sudden loss of blood supply to the brain leading to permanent tissue damage caused by thrombotic, embolic, or hemorrhagic events, ranks as the third leading cause of death (behind only heart disease and cancer) in patients aged 50 years and older. The psychiatric complications of stroke lesions, although recognized for more than 100 years, 1 have never received the attention that has been devoted to poststroke motor deficits, language problems, or intellectual disturbances. Some of these psychiatric complications of stroke, such as depression, have been a focus of research, whereas other complications, such as anxiety or emotional lability, have received relatively little attention. Our paper reviews the world's literature on PSD. NIH Public Access Results DiagnosisThe method for diagnosis of depression among patients with stroke is to conduct a structured or semi-structured MMSE using instruments such as the SCID 2 or the CIDI. 3 The type of symptoms, their severity, and their duration are applied to DSM-IV 4 diagnostic ...

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