Post Stroke Depression Frequently Overlooked, Undiagnosed, Untreated

Abstract

Depression is the most frequently seen neuropsychiatric manifestation in stroke patients. It hampers the ability to undergo therapy and impairs their functional outcome. Depression also increases the risk of suicide in stroke patients, therefore, increasing mortality. The etiology of post-stroke depression (PSD) is complex and reported to be multi-factorial in origin. It also depends on the size and location of the infarct. In addition, family history or prior history of depressive disorders makes them prone to be affected with depression following a stroke. In this article, we will mention various aspects of PSD, as well as the prevalence and the different screening assessment tools used in literature studies. Although there are many available testing tools, little consistency was seen in them being valid or reliable. We will also discuss the pathophysiology of depression in stroke patients with various available options for managing the condition. We will briefly review the use of alternative treatment such as Electroconvulsive therapy (ECT) and Transcranial Magnetic Stimulation (TMS) as well. However, we need further evidence-based research exploring the screening tool; i.e. universally acceptable for PSD and implementing an effective, non-invasive treatment modality impacting the prognosis. Also, we require further investigations to identify the role of antidepressants in the recovery of stroke patients. Keywords:Stroke, Post-stroke depression, Stroke location, Assessment and Treatment, Post-stroke Depression, Prevalence of PSD, Pathology in PSD, Mood disorders in PSD, Symptoms and diagnosis criteria in PSD, Assessment scales in PSD, Pharmacotherapy and other treatments in PSD, Depression in stroke survivors MethodologyA search for relevant published literature was performed using PubMed, Google Scholar. The keywords and phrases used included: Stroke lesion, post stroke depression, major depression, Post stroke symptoms, assessment and treatment. Other relevant studies were found by a review of the primary studies obtained in the search as well as reference tracing of selected articles. The inclusion and exclusion criteria were: Any articles that reported the symptomatology, pathophysiology, evaluation and treatment of post stroke depression. All research studies which were published in English language from Neuropsychiatry (London) (2017) 7(6) 907 Review Ali Mahmood Khan PrevalenceOn average for every 40 seconds, there is a stroke case in the United States -around 600.000 new stroke cases are evident every year [12,13]. Based on the literature studies, there is variability in data reported about PSD prevalence. These differences are usually due to the variations in criteria used to diagnose PSD and the difference in age of patients studied. The higher prevalence was seen in hospital-based settings rather than community-based settings [14].While several clinicians use DSM-III and DSM-IV criteria to reach the diagnosis of PSD, some use a different kind of scales or questionnaires. Also, different clin...

Depression and the Use of Selective Serotonin Reuptake Inhibitors in Patients with Acute Intracerebral Hemorrhage

“…ICH is usually associated with poor health-related quality of life (HRQOL) [15]. Early and accurate identification and appropriate treatment of post-ICH depression are of vital importance for decreasing morbidity and mortality associated with it [1,8].…”

“…Additionally, Sallinen et al showed that feelings of depression prior to the onset of ICH serve as a significant predictor of developing post-ICH depression in patients [16]. SSRIs are the pharmacological treatment of choice in PSD due to their additional benefits of improving neurogenesis and neuroplasticity, which help in physical and cognitive recovery in stroke patients while also having the least cholinergic and cardiovascular adverse effects [8,17-19]. It may be argued that due to a possible increased risk of bleeding complications [10], SSRIs should be withheld from ICH patients.…”

“…Significantly, 75% of the patients meeting the diagnostic criteria did not receive appropriate treatment in our study. PSD is often unrecognized and inappropriately treated [4,8]. Diagnosis of depression, especially in acute stroke patients, has proven to be challenging.…”

“…American Stroke Association has not released any guidelines regarding assessment, treatment, and prevention of depression in ICH patients [1,4]. Considering the above-mentioned challenges in diagnosis, we believe that developing a specific screening tool for the identification of stroke-specific depressive symptoms, such as sensory loss and cognitive deficits, may increase the sensitivity of depression diagnosis in stroke patients [8]. None of the patients in our study underwent psychotherapy.…”

“…Very few studies have documented the incidence, diagnosis, and management of PSD in developing countries. The pathophysiology of depression in the very early phase of stroke is not well understood [1,8]. Most of the guidelines related to the treatment of stroke and ICH do not address the optimal ways to identify and treat depression in these patients.…”