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  • Updated 01.20.2022
  • Released 06.20.1997
  • Expires For CME 01.20.2025

Depression after stroke

Introduction

Overview

Depression occurs in approximately 33% of stroke survivors. It impairs rehabilitation and is associated with increased disability, cognitive impairment, and increased mortality. Both major depression and minor (dysthymic) depression may occur after stroke. Major depression is mainly associated with lesions of the left frontal cortex and basal ganglia. Dysfunction of biogenic amines may explain poststroke depression. Poststroke depression may be adequately treated with antidepressant drugs. Preexisting depression, cognitive impairment, anxiety, and stroke severity are the major predictors of depression after stroke.

Key points

• Approximately one third of stroke survivors suffer from depression during the first year after stroke.

• Depression impairs rehabilitation by contributing to cognitive dysfunction and burdens caregivers with additional stress.

• Antidepressant medications may prevent depression after stroke.

• Selective serotonin reuptake inhibitors are the mainstay of treatment of poststroke depression.

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

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 (82). In 1914 Babinski reported a high prevalence of euphoria, indifference, and denial of illness in patients with right hemisphere lesions (09). Some years later, Bleuler noted that after stroke "melancholic moods lasting for months and sometimes longer appear frequently" (17), and Kraepelin recognized an association between manic-depressive insanity and cerebrovascular disease (65).

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