Depression after Subarachnoid Hemorrhage: A Systematic Review

Abstract

Background and Purpose Depression is common and debilitating illness accompanying many neurological disorders including non-traumatic subarachnoid hemorrhage (SAH). The aim of this systematic review was to identify and critically appraise all published studies that have reported the frequency, severity and time course of depression after SAH, the factors associated with its development and the impact of depression on patients’ quality of life after SAH.Methods The PubMed database was searched for studies published in English that recruited at least 40 patients (>18 years old) after SAH who were also diagnosed with depression.Results Altogether 55 studies covering 6,327 patients met study entry criteria. The frequency of depression ranged from 0% to 61.7%, with a weighted proportion of 28.1%. Depression remained common even several years after the index SAH. Depression after SAH was associated with female sex, premorbid depression, anxiety, substance use disorders or any psychiatric disorders, and coping styles. Comorbid cognitive impairment, fatigue, and physical disability also increased the risk of depression. Aneurysmal SAH and infarction may be related to depression as well. Depression reduces the quality of life and life satisfaction in patients after SAH.Conclusions Depression is common after SAH and seems to persist. Further research is needed to clarify its time course and identify the neuroendocrine and neurochemical factors and brain circuits associated with the development of post-SAH depression. Randomized controlled treatment trials targeting SAH-related depression are warranted.

Fatigue After Aneurysmal Subarachnoid Hemorrhage: Clinical Characteristics and Associated Factors in Patients With Good Outcome

“…Although the prevalence of mood disorders after aSAH is high (Al-Khindi et al, 2010 ; Rinkel and Algra, 2011 ; Vetkas et al, 2013 ; Tang et al, 2020 ), few studies have examined the relationship between mood disorders and post-aSAH fatigue. Passier et al ( 2011a ) found higher fatigue scores 1 year after the ictus in patients scoring high on anxiety and depression than in those without such complaints 3 months after aSAH.…”

“…Even though the mortality rates are high, survival has improved due to early intervention and advances in management. Remarkably, most aSAH survivors recover without significant neurological deficits, however, even patients with good outcome report substantial problems with fatigue, as well as cognitive and emotional problems (Al-Khindi et al, 2010 ; Nordenmark et al, 2019a ; Nussbaum et al, 2020 ; Tang et al, 2020 ). Fatigue represents the most frequent symptom after aSAH and is found in 50–70% of patients even several years after the hemorrhage (Kutlubaev et al, 2012 ; Western et al, 2020 ).…”

Endogenous calcitonin gene-related peptide in cerebrospinal fluid and early quality of life and mental health after good-grade spontaneous subarachnoid hemorrhage—a feasibility series

“…Anxiety and depression [ 11 , 17 , 18 ] are among the most investigated realms of patient outcome after aSAH with a stable prevalence over the 18-month period after aSAH and an estimated frequency ranging from 27 to 54% and from 5 to 50% in aSAH survivors, respectively [ 9 ]. Likewise, somatoform disorders, especially pain syndromes like cephalgia, are a commonly reported and oftentimes a long-lasting symptom burden after sSAH, plausibly affecting Ghp, poorer performance in several cognitive domains, and reduced hrQoL after sSAH [ 9 , 74 ].…”

“…The survivors harbor serious risks of neurological dysfunction, functional disability, and cognitive impairment [ 9 , 10 ], even months to years after ictus [ 11 , 12 ]. There is a marked disparity between reattained functional independence in up to 70% [ 13 ] of the sSAH patients and considerable long-term neuropsychological deficits [ 9 , 10 , 14 ] in up to 94.6% [ 15 ] with a reduced health-related quality of life (hrQoL) in 35% of the patients 1 year after sSAH [ 12 , 16 ], anxiety (in up to 54%) [ 11 , 17 ], depression (approaching 61.7%) [ 17 , 18 ], and, in up to two-thirds [ 9 , 19 ], the inability to reassume one’s previous occupation [ 19 , 20 ] [ 9 , 14 ].…”

Evaluation of the Results of Therapeutic Management of Patients Treated Endovascularly for Cerebral Aneurysm

“…Although brain aneurysms are still a major challenge for neurosurgeons, SAH mortality has decreased by 17% over the past thirty years [17,18]; a similar decrease in mortality of 18-19% is reported by other authors [19,20]. Unfortunately, many people who survive SAH have long-term cognitive deficits and a reduced quality of life [21].…”