Depression after stroke

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By Tarakad S Ramachandran MD and Arun Ramachandran MD

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.

In This Article

Historical note and nomenclature
Clinical manifestations
Clinical vignette
Pathogenesis and pathophysiology
Differential diagnosis
Diagnostic workup
Prognosis and complications
References cited