Affective disorders in neurologic disease

Sergio E Starkstein MD (Dr. Starkstein of the University of Western Australia has no relevant financial relationships to disclose.)
Jaime Pahissa MD (Dr. Pahissa of the Instituto Universitario CEMIC has no relevant financial relationships to disclose.)
Victor W Mark MD, editor. (Dr. Mark of the University of Alabama at Birmingham has no relevant financial relationships to disclose.)
Originally released March 3, 1999; last updated April 3, 2017; expires April 3, 2020

This article includes discussion of affective disorders in neurologic disease, depressive disorders, affective disorders in stroke, affective disorders in Parkinson disease, affective disorders in multiple sclerosis, affective disorders in traumatic brain injury, affective disorders in epilepsy, affective disorders in Huntington disease, affective disorders in Alzheimer disease. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.


In this article, the authors review the frequency, diagnostic strategies, clinical correlates, mechanism, differential diagnoses, and management of affective disorders in frequent acute and chronic neurologic disorders, such as stroke, traumatic brain injury, dementia, Parkinson disease, Huntington disease, multiple sclerosis, and epilepsy. Studies using sophisticated neuroimaging techniques have provided important clues regarding the mechanism of depression and disinhibition in neurologic conditions. Randomized clinical trials have been reported for depression in stroke, Parkinson disease, and Alzheimer disease as well as for the prevention of depression after stroke.

Key points


• Mortality in stroke may be reduced by the use of antidepressants.


• Randomized controlled trials showed the efficacy of antidepressants and cognitive behavior therapy for depression in Parkinson disease.


• Antidepressants demonstrated good efficacy for agitation in Alzheimer disease.

Historical note and terminology

Depression has been recognized as a frequent concomitant of neurologic disease (Starkstein and Robinson 1993). In 1861, Reynolds noted that depression and timidity are common symptoms in the interval between seizures in epileptic individuals (Reynolds 1861). In 1877, Charcot described the emotional changes in patients with multiple sclerosis, noting that "the dominant feeling in the patients appears to be a sort of almost stupid indifference. It is not rare to see them give way to foolish laughter for no cause and sometimes, on the contrary, melt into tears without reason" (Charcot 1877). In 1916, Kraepelin wrote that a cerebrovascular disorder may be an accompanying phenomenon of manic-depressive disease or may itself engender states of depression. He also noted that patients in his clinic with Huntington disease often had manic-depressive illness (Kraepelin 1916). Both Babinski in 1914 and Kraepelin in 1916 described an association between traumatic brain injury and depression (Babinski 1914; Kraepelin 1916). In 1924, Janet recognized the association between depression and Parkinson disease and explained the mood disorder as secondary to psychological trauma (Janet 1924).

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