Depression after stroke

Tarakad S Ramachandran MD (Dr. Ramachandran of SUNY Upstate Medical University has no relevant financial relationships to disclose.)
Arun Ramachandran MD (Dr. Ramachandran of the State University of New York at Syracuse has no relevant financial relationships to disclose.)
Steven R Levine MD, editor. (Dr. Levine of the SUNY Health Science Center at Brooklyn has received honorariums from Genentech for service on a scientific advisory committee and a research grant from Genentech as a principal investigator.)
Originally released June 20, 1997; last updated September 4, 2015; expires September 4, 2018

Overview

Poststroke depression, the second most serious psychosomatic complication after brain stroke, leads to delay of the rehabilitation process and is associated with an increased disability and cognitive impairment along with increase in term mortality.

Two depressive syndromes, major depression and minor (dysthymic) depression, have been reported in patients with stroke lesions. Major poststroke depression is associated with lesions involving left cortical (mainly frontal) and subcortical (mainly basal ganglia) regions. Dysfunction of biogenic amines may play an important role in the mechanism of poststroke depression. Most studies reported a prevalence of poststroke depression of about 40%. Poststroke depression may be adequately treated with antidepressant drugs. Depression pre-stroke, cognitive impairment, stroke severity, and anxiety are the major predictors of depression after stroke.

Key points

 

• Depression after stroke often goes undetected, or if diagnosed, is inadequately treated. As much as a third of stroke survivors suffer from depression during the first year after the onset of stroke.

 

• Depression interferes with rehabilitation by causing physical and cognitive function impairment, and it predisposes caregivers to enormous additional stress.

 

• The role of intervention for preventing depression after stroke remains unclear.

 

• Well-designed clinical trials are needed to test the best strategies against depression across all survivors of stroke.

Historical note and terminology

In 1904 Adolf Meyer reported the possibility of a relationship between traumatic insanities and specific locations and causes of brain injury (Meyer 1904). In 1914 Babinski reported a high prevalence of euphoria, indifference, and denial of illness in patients with right hemisphere lesions (Babinski 1914). Some years later, Bleuler noted that after stroke "melancholic moods lasting for months and sometimes longer appear frequently" (Bleuler 1951), and Kraepelin recognized an association between manic-depressive insanity and cerebrovascular disease (Kraepelin 1921).

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