Depression

Abstract

Poststroke depression (PSD) affects about one third of stroke survivors and is of importance as individuals with PSD are at a higher risk for poorer recovery, recurrent vascular events, lower quality of life, and mortality. The most consistent predictors of PSD are physical disability, stroke severity, history of depression, and cognitive impairment. However, further studies are needed to develop a better understanding of predictors of PSD. Several trials have suggested that antidepressant or other medications may be effective in treating PSD; however, further research is needed in more representative samples of stroke survivors to determine optimal timing, threshold, and medications for treatment. Brief psychosocial interventions may be useful and effective in treatment of PSD but whether antidepressant medication is a necessary or beneficial adjuvant cannot be established from these trials because of a lack of placebo controls. A number of trials have suggested that psychosocial therapies may prevent the development of PSD; however, the studies are not generalizable to all stroke survivors, given their narrow inclusion and exclusion criteria. Further research with more rigorous methods is needed to assess the effect of psychotherapy on the prevention of PSD. Early identification and intervention have been shown to improve functional outcomes. However, there is no consistency in the tools used to measure PSD, and the assessment of confounders in studies that assess PSD. Clinical and epidemiological studies should harmonize the use of screening tools and optimal timepoints to assess PSD in order to facilitate collaborative studies. PSD likely involves a combination of biological and psychosocial factors. There needs to be a greater understanding of the relationship of patient, social and stroke related factors, and their contributions to the development of PSD in order to facilitate the development of targeted interventions for prevention and treatment.