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Approach to Depression in Patients with Brain Diseases: Stroke, Parkinson’s Disease, and Dementia

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Abstract

The physical and/or psychological sequelae caused by stroke, Parkinson’s disease, and dementia may be devastating for both the patient and family. Depression during these illnesses not only complicates diagnosis and treatment but also hinders therapeutic efforts. SSRIs and tricyclic antidepressants are known to be effective in poststroke depression. These antidepressants should be continued at least for 4 months after initial recovery and should be changed if no response is seen after 6 weeks. Psychotherapy including cognitive behavioral therapy can be tried for patients with milder depression and those with side effects or contraindications to the use of antidepressants. Multidisciplinary and integrative approaches are recommended for assessing and treating poststroke depression. Tricyclic antidepressants as well as bupropion and SSRIs help improve depression in patients with Parkinson’s disease. However, bupropion, SSRIs, and venlafaxine are preferred drugs for depressed patients with dementia because they cause less cognitive impairment and sedative action than tricyclic antidepressants. Overall, therapeutic approaches to Parkinson’s disease or dementia comorbid with depression may involve a combination of psychopharmacological treatment and psychotherapeutic interventions including behavioral treatment.

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References

  1. Whyte EM, Mulsant BH. Post-stroke depression: epidemiology, pathophysiology, and biological treatment. Biol Psychiatry. 2002;52:253–64.

    PubMed  Google Scholar 

  2. Robinson RG, Spalletta G. Poststroke depression: a review. Can J Psychiatr. 2010;55:341–9.

    Google Scholar 

  3. Robinson RG. Neuropsychiatric consequences of stroke. Annu Rev Med. 1997;48:217–29.

    PubMed  Google Scholar 

  4. Wolfe CDA. The impact of stroke. Br Med Bull. 2000;56:275–86.

    PubMed  Google Scholar 

  5. Williams LS, Ghose SS, Swindle RW. Depression and other mental health diagnoses increase mortality risk after ischemic stroke. Am J Psychiatry. 2004;161:1090–5.

    PubMed  Google Scholar 

  6. Hackett M, Anderson C. Treatment options for post-stroke depression in the elderly. Aging Health. 2005;1:95–105.

    Google Scholar 

  7. Murphy E. Social origins of depression in old age. Br J Psychiatry. 1982;141:134–42.

    Google Scholar 

  8. De Ryck A, Brouns R, Fransen E, et al. A prospective study on the prevalence and risk factors of poststroke depression. Cerebrovasc Dis Extra. 2013;3:1–13.

    PubMed  PubMed Central  Google Scholar 

  9. Cohen-Cole SA, Harpe C. Assessment of depression in the medically ill. In: Stoudemire A, Fogel BS, editors. Principles of medical psychiatry. Orlando: Grune & Stratton; 1987.

    Google Scholar 

  10. Cassem NH. Depression. In: Cassem NH, editor. MGH handbook of general hospital psychiatry. St. Louis: Mosby-Year Book; 1991.

    Google Scholar 

  11. Lenze E, Rogers J, Martire L, et al. The association of late-life depression and anxiety with physical disability: a review of the literature and prospectus for future research. Am J Geriatr Psychiatry. 2001;9:113–35.

    PubMed  Google Scholar 

  12. Austin M, Mitchell P, Goodwin G. Cognitive deficits in depression: possible implications for functional neuropathology. Br J Psychiatry. 2001;178:200–6.

    PubMed  Google Scholar 

  13. Butters M, Becker J, Nebes R, et al. Changes in cognitive functioning following treatment of late-life depression. Am J Psychiatry. 2000;157:1949–54.

    PubMed  Google Scholar 

  14. Gillen RTH, McKee TE, Gernert-Dott P, et al. Depressive symptoms and history of depression predict rehabilitation efficiency in stroke patients. Arch Phys Med Rehabil. 2001;82:1645–9.

    PubMed  Google Scholar 

  15. Paolucci S, Antonucci G, Grasso M, et al. Poststroke depression, antidepressant treatment and rehabilitation results: a case-controlled study. Cerebrovasc Dis. 2001;12:264–71.

    PubMed  Google Scholar 

  16. Schulz R, Beach S, Ives D, et al. Association between depression and mortality in older adults: The Cardiovascular Health Study. Arch Intern Med. 2000;160:1761–8.

    PubMed  Google Scholar 

  17. Ensinck K, Schuurman A, van den Akker M, et al. Is there an increased risk of dying after depression? Am J Epidemiol. 2002;156:1043–8.

    PubMed  Google Scholar 

  18. Glassman A, Shapiro P. Depression and the course of coronary artery disease. Am J Psychiatry. 1998;155:4–11.

    PubMed  Google Scholar 

  19. Rabins P. Barriers to diagnosis and treatment of depression in elderly patients. Am J Geriatr Psychiatry. 1996;4:79–83.

    Google Scholar 

  20. Schubert D, Taylor C, Lee S, et al. Detection of depression in the stroke patient. Psychosomatics. 1992;33:290–4.

    PubMed  Google Scholar 

  21. Christensen H, Jorm A, Mackinnon A, et al. Age differences in depression and anxiety symptoms: a structural equation modeling analysis of data from a general population sample. Psychol Med. 1999;29:325–39.

    PubMed  Google Scholar 

  22. Meader N, Moe-Byrne T, Llewellyn A, et al. Screening for poststroke major depression: a meta-analysis of diagnostic validity studies. J Neurol Neurosurg Psychiatry. 2014;85:198–206.

    PubMed  Google Scholar 

  23. Agrell B, Dehlin O. Comparison of six depression rating scales in geriatric stroke patients. Stroke. 1989;20:1190–4.

    PubMed  Google Scholar 

  24. Carod-Artal F, Ferreira Coral L, Trizotto D, et al. Poststroke depression: prevalence and determinants in Brazilian stroke patients. Cerebrovasc Dis. 2009;28:157–65.

    PubMed  Google Scholar 

  25. Strober LB, Arnett PA. Assessment of depression in three medically ill, elderly populations: Alzheimer’s disease, Parkinson’s disease, and stroke. Clin Neuropsychol. 2009;23:205–30.

    PubMed  Google Scholar 

  26. Laidlaw K. Poststroke depression and CBT with older people. In: Dolores G-T, Ann MS, Lary WT, editors. Handbook of behavioral and cognitive therapies with older adults. New York: Springer; 2007.

    Google Scholar 

  27. Alexopoulos G, Buckwalter K, Olin J, et al. Comorbidity of late life depression: an opportunity for research on mechanisms and treatment. Biol Psychiatry. 2002;52:543–58.

    PubMed  Google Scholar 

  28. Lokk J, Delbari A. Management of depression in elderly stroke patients. Neuropsychiatr Dis Treat. 2010;6:539–49.

    PubMed  PubMed Central  Google Scholar 

  29. Gusev E, Bogolepova A. Depressive disorders in stroke patients. Neurosci Behav Physiol. 2009;39:639–43.

    PubMed  Google Scholar 

  30. Chen Y, Guo JJ, Zhan S, et al. Treatment effects of antidepressants in patients with post-stroke depression: a meta-analysis. Ann Pharmacother. 2006;40:2115–22.

    PubMed  Google Scholar 

  31. Starkstein SE, Mizrahi R, Power BD. Antidepressant therapy in post-stroke depression. Expert Opin Pharmacother. 2008;9:1291–8.

    PubMed  Google Scholar 

  32. Cunningham LA. Depression in the medically ill: choosing an antidepressant. J Clin Psychiatry. 1994;55(Suppl AJ):90–7.

    PubMed  Google Scholar 

  33. Snow V, Lascher S, Mottur-Pilson C. Pharmacologic treatment of acute major depression and dysthymia: clinical guideline, part 1. Ann Intern Med. 2000;132:738–42.

    PubMed  Google Scholar 

  34. Turner-stokes L, Hassan N. Depression after stroke: a review of the evidence base to inform the development of an integrated pathway. Part 1: diagnosis, frequency and impact. Clin Rehabil. 2002;16:231–47.

    PubMed  Google Scholar 

  35. Williams LS. Depression and stroke: cause or consequence? Semin Neurol. 2005;25:396–409.

    PubMed  Google Scholar 

  36. Paolucci S. Epidemiology and treatment of post-stroke depression. Neuropsychiatr Dis Treat. 2008;4:145–54.

    PubMed  PubMed Central  Google Scholar 

  37. Scogin F, Welsh D, Hanson A, et al. Evidence-based psychotherapies for depression in older adults. Clin Psychol Sci Pract. 2006;12:222–37.

    Google Scholar 

  38. Watkins C, Auton M, Deans C, et al. Motivational interviewing early after acute stroke: a randomized, controlled trial. Stroke. 2007;38:1004–9.

    PubMed  Google Scholar 

  39. Gallagher-Thompson D, Steffen A, Thompson L, et al. Handbook of behavioral and cognitive therapies with older adults. New York: Springer; 2008.

    Google Scholar 

  40. Gebretsadik M, Jayaprabhu S, Grossberg G. Mood disorders in the elderly. Med Clin North Am. 2006;90:789–805.

    PubMed  Google Scholar 

  41. Lincoln N, Flannaghan T. Cognitive behavioral psychotherapy for depression following stroke: a randomized controlled trial. Stroke. 2003;34:111–5.

    PubMed  Google Scholar 

  42. Hackett M, Anderson C, House A. Interventions for treating depression after stroke. Stroke. 2009;40:e487–e8.

    Google Scholar 

  43. Australian R. Australian and new Zealand clinical practice guidelines for the treatment of depression. Aust N Z J Psychiatry. 2004;38:389–407.

    Google Scholar 

  44. Lai SM, Studenski S, Richards L, et al. Therapeutic exercise and depressive symptoms after stroke. J Am Geriatr Soc. 2006;54:240–7.

    PubMed  Google Scholar 

  45. Fiske A, Wetherell J, Gatz M. Depression in older adults. Ann Rev Clin Psychol. 2009;5:363–89.

    Google Scholar 

  46. Turner-Stokes L, Hassan N, et al. Managing depression in brain injury rehabilitation: the use of an integrated care pathway and preliminary report of response to sertraline. Clin Rehabil. 2002;16:261–8.

    PubMed  Google Scholar 

  47. Beck AT, Ward CH, Mendelssohn MJ, et al. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561–71.

    PubMed  Google Scholar 

  48. Gordon WA, Hibbard MR, Egelko S, et al. Issues in the diagnosis of post-stroke depression. Rehabil Psychol. 1991;36:71–87.

    Google Scholar 

  49. Sutcliffe LM, Lincoln NB. The assessment of depression in aphasic stroke patients: the development of the Stroke Aphasic Depression Questionnaire. Clin Rehabil. 1998;12:506–13.

    PubMed  Google Scholar 

  50. Koh KB. Poststroke depression: mechanisms and management. In: Koh KB, editor. Somatization and psychosomatic symptoms. New York: Springer; 2013.

    Google Scholar 

  51. McNamara ME. Neurology. In: Stoudemire A, Fogel BS, editors. Principles of medical psychiatry. Orlando: Grune & Stratton; 1987.

    Google Scholar 

  52. Mayeux R, Stern Y, Cote L. Altered serotonin metabolism in depressed patients with Parkinson’s disease. Neurology. 1984;34:642–6.

    PubMed  Google Scholar 

  53. Mayeux R, Stern Y, Williams JB. Clinical and biochemical features of depression in Parkinson’s disease. Am J Psychiatry. 1986;143:756–9.

    PubMed  Google Scholar 

  54. Wen MC, Chan LL, Tan LC, et al. Depression, anxiety, and apathy in Parkinson’s disease: insights from neuroimaging studies. Eur J Neurol. 2016;23:1001–19.

    PubMed  Google Scholar 

  55. Goodarzi Z, Mrklas KJ, Roberts DJ, et al. Detecting depression in Parkinson disease: a systematic review and meta-analysis. Neurology. 2016;87:426–37.

    PubMed  PubMed Central  Google Scholar 

  56. Torbey E, Pachana NA, Dissanayaka NN. Depression rating scales in Parkinson's disease: a critical review updating recent literature. J Affect Disord. 2015;184:216–24.

    PubMed  Google Scholar 

  57. Cummings JL. Depression and Parkinson’s disease: a review. Am J Psychiatry. 1992;149:443–54.

    PubMed  Google Scholar 

  58. Goetz CG, Tanner CM, Klawans HL. Bupropion in Parkinson’s disease. Neurology. 1984;34:1092–4.

    PubMed  Google Scholar 

  59. Bouchard RH, Pourcher E, Vincent P. Fluoxetine and extrapyramidal side effects [letter]. Am J Psychiatry. 1989;146:1352–3.

    Google Scholar 

  60. Meltzer HY, Young M, Metz J. Extrapyramidal side effects and increased serum prolactin following fluoxetine, a new antidepressant. J Neural Transm. 1979;45:165–75.

    PubMed  Google Scholar 

  61. Yang S, Sajatovic M, Walter BL. Psychosocial interventions for depression and anxiety in Parkinson’s disease. J Geriatr Psychiatry Neurol. 2012;25:113–21.

    PubMed  Google Scholar 

  62. Armento ME, Stanley MA, Marsh L, et al. Cognitive behavioral therapy for depression and anxiety in Parkinson’s disease: a critical review. J Parkinsons Dis. 2012;2:135–51.

    PubMed  Google Scholar 

  63. Egan SJ, Laidlaw K, Starkstein S. Cognitive behavioral therapy for depression and anxiety in Parkinson’s disease. J Parkinsons Dis. 2015;5:443–51.

    PubMed  PubMed Central  Google Scholar 

  64. Quelhas R. Psychiatric care in Parkinson’s disease. J Psychiatr Pract. 2013;19:118–41.

    PubMed  Google Scholar 

  65. Slaby AE, Cullem LO. Dementia and delirium. In: Stoudemire A, Fogel BS, editors. Principles of medical psychiatry. Orlando: Grune & Stratton; 1987.

    Google Scholar 

  66. McCarthy JR, Palmateer LM. Assessment of cognitive deficit in geriatric patients: a study of physician behavior. J Am Geriatr Soc. 1985;33:467–71.

    Google Scholar 

  67. Doody RS, Stevens JC, Beck C, et al. Practice parameter: management of dementia(an evidence based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2001;56:1154–66.

    PubMed  Google Scholar 

  68. Lyketsos CG, Olin JT. Depression in Alzheimer disease: overview and treatment. Biol Psychiatry. 2002;52:243–52.

    PubMed  Google Scholar 

  69. Olin JT, Schneider LS, Katz IR, et al. National Institute of Mental Health-Provisional Diagnostic Criteria for Depression of Alzheimer Disease: rationale and background. Am J Geriatr Psychiatry. 2002;10:125–8.

    Google Scholar 

  70. Reifler BV, Larson E, Teri L. Dementia of the Alzheimer’s type and depression. J Am Geriatr Soc. 1986;34:855–9.

    PubMed  Google Scholar 

  71. Lazarus LW, Newton N, Cohler B. Frequency and presentation of depressive symptoms in patients with primary degenerative dementia. Am J Psychiatry. 1987;144:41–5.

    PubMed  Google Scholar 

  72. Burns A, Jacoby R, Levy R. Psychiatric phenomena in Alzheimer disease, III: disorders of mood. Br J Psychiatry. 1990;157:81–6.

    PubMed  Google Scholar 

  73. Lyketsos CG, Steinberg M, Tschantz J, et al. Mental and behavioral disturbances in dementia: findings from the Cache County study on memory in aging. Am J Psychiatry. 2000;157:708–14.

    PubMed  Google Scholar 

  74. Fischer P, Simanyi M, Danielczyk W. Depression in dementia of the Alzheimer type and in multi-infarct dementia. Am J Psychiatry. 1990;147:1484–7.

    PubMed  Google Scholar 

  75. Reding M, Haycox J, Blass J. Depression in patients referred to a dementia clinic: a three year prospective study. Arch Neurol. 1985;42:894–6.

    PubMed  Google Scholar 

  76. Katz IR. Diagnosis and treatment of depression in patients with Alzheimer’s disease and other dementia. J Clin Psychiatry. 1998;59(Suppl 9):38–44.

    PubMed  Google Scholar 

  77. Goodarzi ZS, Mele BS, Roberts DJ, et al. Depression case finding in individuals with dementia: a systematic review and meta-analysis. J Am Geriatr Soc. 2017;65:937–48.

    PubMed  Google Scholar 

  78. Conn D, Thorpe L. Assessment of behavioral and psychological symptoms associated with dementia. Can J Neurol Sci. 2007;34(Suppl 1):S67–71.

    PubMed  Google Scholar 

  79. Gutzmann H, Qazi A. Depression associated with dementia. Z Gerontol Geriatr. 2015;48:305–11.

    PubMed  Google Scholar 

  80. Bains J, Birks J, Denning T. Antidepressants for treating depression in dementia. Cochrane Database Syst Rev. 2002;21:CD003944.

    Google Scholar 

  81. Lyketsos CG, DelCampo L, Steinberg M, et al. Treating depression in Alzheimer disease: efficacy and safety of sertraline therapy, and the benefits of depression reduction: the DIADS. Arch Gen Psychiatry. 2003;60:737–46.

    PubMed  Google Scholar 

  82. Raskind MA. The clinical interface of depression and dementia. J Clin Psychiatry. 1998;59(Suppl 10):9–12.

    PubMed  Google Scholar 

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  1. Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea

    Kyung Bong Koh

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Koh, K.B. (2018). Approach to Depression in Patients with Brain Diseases: Stroke, Parkinson’s Disease, and Dementia. In: Stress and Somatic Symptoms. Springer, Cham. https://doi.org/10.1007/978-3-030-02783-4_15

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