G Espárrago Llorca1, L Castilla-Guerra2, M C Fernández Moreno3, S Ruiz Doblado1, M D Jiménez Hernández4. 1. Servicio de Psiquiatría, Hospital de la Merced, Osuna, Sevilla, España. 2. Servicio de Medicina Interna, Hospital de la Merced, Osuna, Sevilla, España. 3. Servicio de Neurología, Hospital de Valme, Sevilla, España. Electronic address: castillafernandez@hotmail.com. 4. Servicio de Neurología y Neurofisiología, Hospital Virgen del Rocío, Sevilla, España.
Abstract
INTRODUCTION: Post-stroke depression (PSD) is the most common mood disorder following a stroke, and also the main factor limiting recovery and rehabilitation in stroke patients. In addition, it may increase mortality by up to ten times. DEVELOPMENT: PSD occurs in 1 in 3 stroke patients and more than half of all cases are neither diagnosed nor treated. Several mechanisms, including biological, behavioral, and social factors, are involved in its pathogenesis. Symptoms usually occur within the first three months after stroke (early onset PSD), and less frequently at a later time (late onset PSD). Symptoms resemble those of other types of depression, although there are some differences: PSD patients experience more sleep disturbances, vegetative symptoms, and social withdrawal. For PSD diagnosis, we recommended vigilance and use of specific diagnostic tools such as the Patient Health Questionnaire-2 (PHQ-2). The treatments of choice are selective serotonin reuptake inhibitors (SSRI). However, there are still many unanswered questions in the treatment of PSD, such as the best time to start treatment or the effects of antidepressants on cognition and motor function, among others. CONCLUSIONS: Neurologists play a pivotal role in the care and management of patients recovering from stroke. They must be familiar with methods for early detection and treatment of PSD, as this can facilitate a patient's functional recovery and social reintegration, and improve quality of life for patients and their families.
INTRODUCTION: Post-stroke depression (PSD) is the most common mood disorder following a stroke, and also the main factor limiting recovery and rehabilitation in strokepatients. In addition, it may increase mortality by up to ten times. DEVELOPMENT: PSD occurs in 1 in 3 strokepatients and more than half of all cases are neither diagnosed nor treated. Several mechanisms, including biological, behavioral, and social factors, are involved in its pathogenesis. Symptoms usually occur within the first three months after stroke (early onset PSD), and less frequently at a later time (late onset PSD). Symptoms resemble those of other types of depression, although there are some differences: PSDpatients experience more sleep disturbances, vegetative symptoms, and social withdrawal. For PSD diagnosis, we recommended vigilance and use of specific diagnostic tools such as the Patient Health Questionnaire-2 (PHQ-2). The treatments of choice are selective serotonin reuptake inhibitors (SSRI). However, there are still many unanswered questions in the treatment of PSD, such as the best time to start treatment or the effects of antidepressants on cognition and motor function, among others. CONCLUSIONS: Neurologists play a pivotal role in the care and management of patients recovering from stroke. They must be familiar with methods for early detection and treatment of PSD, as this can facilitate a patient's functional recovery and social reintegration, and improve quality of life for patients and their families.
Authors: Anson B Rosenfeldt; Susan M Linder; Sara Davidson; Cynthia Clark; Nicole M Zimmerman; John J Lee; Jay L Alberts Journal: Arch Phys Med Rehabil Date: 2018-12-10 Impact factor: 3.966