Post stroke depression: clinics, etiopathogenesis and therapeutics

Abstract

Background: Stroke is a major cause of morbidity and mortality worldwide. Neuropsychiatric disorders are often associated with stroke and, among them, depression is the most prevalent. Post-stroke Depression (PSD) is related to disability, failure in returning to work, impairment in interpersonal functioning and mortality. Its etiopathogenesis is still uncertain, as well as its treatment. In Brazil, there are few data on the impact of PSD. Objective: This work is dedicated to conduct a comprehensive review of the concept of PSD, its pathophysiology, morbidity and treatment. Methods: PubMed, Medline and Lilacs searches of relevant terms yielded 3,265 papers in the last 10 years. We selected original studies and reviews that addressed the aspects mentioned above. Results: We present the history of the notion of PSD and describe its epidemiology, looking to highlight Brazilian studies. Diagnostic criteria and clinical presentation were detailed, with emphasis on cognitive aspects. The four main pathophysiological theories proposed to PSD are presented and we discuss the various treatment strategies, involving psychopharmacologic options, brain stimulation techniques and psychotherapy. Discussion: This work provides comprehensive information on PSD, of great utility for clinical practice and research in this topic.

Long-range temporal correlations of broadband EEG oscillations for depressed subjects following different hemispheric cerebral infarction

“…Lesion location was one of the major biological theories on the pathophysiology of post-stroke depression (Pedroso et al, 2015;Zhang et al, 2012;Robinson, 2003Robinson, , 2006Robinson and Coyle, 1980), despite the inconsistency in association between depression and the location of brain lesions as a result of a stroke. Stroke lateralization was not related to depressive occurrence and symptoms in the present study, but a definite difference of the LRTC in broadband EEG oscillation was found among depressive patients with different lesion sides, which implied that the generation of depressive disorders with different hemisphere damage may be different and supports the notion that the association between depression following cerebral infarction and lesion location may be more complex than previously suggested (Sinyor et al, 1986;Bhogal et al, 2004;Wang et al, 2017).…”

“…Depressive disorder, which refers to emotional disorders with main symptoms of dropped interest and depression, is one of the most common emotional disorders afflicting stroke sufferers, which impedes the rehabilitation and recovery process, jeopardizes quality of life and severely increases mortality (Berg et al, 2003;Gaete and Bogousslavsky, 2008;De Man-Van Ginkel et al, 2013). Its pathophysiological mechanism has not yet been fully elucidated and is assumed to be a multifactorial process involving biological, behavioural and social factors (Chemerinski et al, 2001;de Coster et al, 2005;Singh et al, 2000;Pedroso et al, 2015;Zhang et al, 2015). Among them, biological and psychological perspectives were two main viewpoints.…”

Psychopathological evaluation and use of the Hospital Anxiety and Depression Scale in a sample of Brazilian patients with post-stroke depression

“…Several factors have been associated with PSD, such as previous history of psychiatric disorders, female gender, family history of depression, and cerebrovascular risk factors, among others 10,26 . Among those, physical disability, stroke severity and cognitive impairment have been more consistently associated with PSD.…”

“…In Brazil, where stroke is the leading cause of death, it is estimated that survivors reach 2.5 million individuals and there is virtually no information on the profile of neuropsychiatric disorders in these patients 10 . Despite limited data on this topic, we recently reviewed Brazilian studies that assessed the prevalence of depression after stroke in different settings and found rates ranging from 20 to 59% 10 .…”

Depression and anxiety one month after stroke

“…Depression and anxiety are the most common mood disorders among stroke survivors with a prevalence of 13.7-31.1% for depression (American Stroke Association, 2014;Ayerbe, Ayis, Wolfe, & Rudd, 2013;Broomfield, Quinn, Abdul-Rahim, Walters, & Evans, 2014;Chriki, Bullain, & Stern, 2006;Pedroso, de Souza, Brunont, & Teixeira, 2015;Schöttke & Giabbiconi, 2015) and 20.0-38.3% for anxiety (American Stroke Association, 2014;Ayerbe, Ayis, Crichton, Wolfe, & Rudd, 2014;Schöttke & Giabbiconi, 2015). Depression or anxiety after stroke not only leads to poor involvement in rehabilitation and delays functional recovery, but results in limited social activity, poor quality of life, and increased disability (De Ryck et al, 2014;Skolarus, Burke, Brown, & Freedman, 2014).…”