Post-Stroke Depression and Antidepressants

Summary

Research indicates that antidepressants may be effective at decreasing depressive symptoms and increasing physical funtioning after stroke.

In the United States, over 795,000 strokes occur every year, and it is a leading cause of long-term disability. Post-stroke depression (PSD) is a common neuropsychiatric complication with prevalence rates ranging between 39% to 52% during the first 5 years after stroke The negative effects of PSD include increased disability, cognitive impairments, mortality, suicidality, and decreased functional rehabilitation and quality of life. Diagnosis and treatment of PSD is complicated by its complex etiology and post-stroke impairments (e.g., cognition, communication, and emotion). Both psychosocial (e.g., role change due to disability) and physiological factors (e.g., lesion location, biochemical dysfunction), may contribute to PSD.  Therefore, PSD is considered to be a biopsychosocial disorder.

Antidepressants are one of the main treatments for PSD and contribute to improving biochemical dysfunction and functional recovery.  Selective serotonin reuptake inhibitors (SSRIs) are the most recommended because they are generally well tolerated.  However, other classes of ADs are shown to be effective and may have advantages for treating co-occurring conditions or in situations where SSRIs are not tolerated or contraindicated..   For example, noradrenaline reuptake inhibitors (NARIs) have been effective in treating PSD characterized by psychomotor problems and serotoninergic and noradrenergic reuptake inhibitors (SNRIs) have been effective in treating PSD with emotional unawareness.   Yet other research indicates that tricyclic antidepressants (TCAs) have a higher response rate for treating PSD when compared to SSRIs. Therefore, effective treatment of PSD may involve selecting antidepressants most suitable for the individual. 

PSD is a complex disorder with multiple causes.  Effective treatment for depression includes antidepressants, which are especially effective for individuals after stroke. Antidepressants are effective as demonstrated by several studies because they help improve neurochemical dysfunction, decrease depressive symtoms, and contribute to improved functional recovery.

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