Poststroke Depression: Mechanisms and Management

  • Kyung Bong KohEmail author


Stroke, defined as a sudden loss of blood supply to the brain leading to permanent damage caused by thrombotic, embolic, or hemorrhagic events, ranks as the leading cause of death in patients aged 50 years and older [1]. Poststroke depression is defined as depression occurring in the context of a clinically apparent stroke [2].


Cognitive Behavioral Therapy Major Depressive Disorder Stroke Survivor Electroconvulsive Therapy Adjustment Disorder 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Robinson, R. G., & Spalletta, G. (2010). Poststroke depression: A review. Canadian Journal of Psychiatry, 55, 341–349.Google Scholar
  2. 2.
    Whyte, E. M., & Mulsant, B. H. (2002). Post-stroke depression: Epidemiology, pathophysiology, and biological treatment. Biological Psychiatry, 52, 253–264.PubMedCrossRefGoogle Scholar
  3. 3.
    Cohen-Cole, S. A., & Harpe, C. (1987). Assessment of depression in the medically ill. In A. Stoudemire & B. S. Fogel (Eds.), Principles of medical psychiatry (pp. 23–36). Orlando, FL: Grune & Stratton.Google Scholar
  4. 4.
    Folstein, M., Maiberger, R., & McHugh, P. (1977). Mood disorder as a specific complication of stroke. Journal of Neurology, Neurosurgery & Psychiatry, 40, 1018–1020.CrossRefGoogle Scholar
  5. 5.
    Robinson, R., Shoemaker, W., Schlumpf, M., et al. (1975). Effect of experimental cerebral infarction in rat brain on catecholamines and behavior. Nature, 255, 332–334.PubMedCrossRefGoogle Scholar
  6. 6.
    Robinson, R., Kubos, K., Starr, L., et al. (1984a). Mood disorders in stroke patients: Importance of location of lesion. Brain, 107, 81–93.PubMedCrossRefGoogle Scholar
  7. 7.
    Starkstein, S. E., Robinson, R. G., Berthier, M. L., et al. (1988). Differential mood changes following basal ganglia versus thalamic lesions. Archives of Neurology, 45, 725–730.PubMedCrossRefGoogle Scholar
  8. 8.
    American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
  9. 9.
    Lenze, E., Rogers, J., Martire, L., et al. (2001). The association of late-life ­depression and anxiety with physical disability: A review of the literature and prospectus for future research. The American Journal of Geriatric Psychiatry, 9, 113–135.PubMedGoogle Scholar
  10. 10.
    Austin, M., Mitchell, P., & Goodwin, G. (2001). Cognitive deficits in depression: Possible implications for functional neuropathology. The British Journal of Psychiatry, 178, 200–206.PubMedCrossRefGoogle Scholar
  11. 11.
    Butters, M., Becker, J., Nebes, R., et al. (2000). Changes in cognitive functioning following treatment of late-life depression. The American Journal of Psychiatry, 157, 1949–1954.PubMedCrossRefGoogle Scholar
  12. 12.
    Gillen, R. T. H., McKee, T. E., Gernert-Dott, P., et al. (2001). Depressive symptoms and history of depression predict rehabilitation efficiency in stroke patients. Archives of Physical Medicine and Rehabilitation, 82, 1645–1649.PubMedCrossRefGoogle Scholar
  13. 13.
    Paolucci, S., Antonucci, G., Grasso, M., et al. (2001). Poststroke depression, antidepressant treatment and rehabilitation results: A case-controlled study. Cerebrovascular Diseases, 12, 264–271.PubMedCrossRefGoogle Scholar
  14. 14.
    Morris, P., Raphael, B., & Robinson, R. (1992). Clinical depression is associated with impaired recovery from stroke. The Medical Journal of Australia, 157, 239–242.PubMedGoogle Scholar
  15. 15.
    Parikh, R., Robinson, R., Lipsey, J., et al. (1990). The impact of poststroke depression on recovery in activities of daily living over a 2-year follow-up. Archives of Neurology, 47, 785–789.PubMedCrossRefGoogle Scholar
  16. 16.
    Robinson, R., Lipsey, J., Rao, K., et al. (1986). Two-year longitudinal study of post-stroke mood disorders: Comparison of acute-onset with delayed-onset depression. The American Journal of Psychiatry, 143, 1238–1244.PubMedGoogle Scholar
  17. 17.
    Schulz, R., Beach, S., Ives, D., et al. (2000). Association between depression and mortality in older adults: The Cardiovascular Health Study. Archives of Internal Medicine, 160, 1761–1768.PubMedCrossRefGoogle Scholar
  18. 18.
    Rabins, P. (1996). Barriers to diagnosis and treatment of depression in elderly patients. The American Journal of Geriatric Psychiatry, 4, 79–83.CrossRefGoogle Scholar
  19. 19.
    Schubert, D., Taylor, C., Lee, S., et al. (1992). Detection of depression in the stroke patient. Psychosomatics, 33, 290–294.PubMedCrossRefGoogle Scholar
  20. 20.
    Poynter, B., Schuman, M., Diaz-Granados, N., et al. (2009). Sex differences in the prevalence of post-stroke depression: A systematic review. Psychosomatics, 50, 563–569.PubMedGoogle Scholar
  21. 21.
    Robinson, R. G. (1997). Neuropsychiatric consequences of stroke. Annual Review of Medicine, 48, 217–229.PubMedCrossRefGoogle Scholar
  22. 22.
    Starkstein, S. E., Mizrahi, R., & Power, B. D. (2008). Antidepressant therapy in post-stroke depression. Expert Opinion on Pharmacotherapy, 9, 1291–1298.PubMedCrossRefGoogle Scholar
  23. 23.
    Cassem, N. H. (1991). Depression. In N. H. Cassem (Ed.), MGH handbook of general hospital psychiatry (pp. 237–268). St. Louis, MO: Mosby-Year Book.Google Scholar
  24. 24.
    Ensinck, K., Schuurman, A., van den Akker, M., et al. (2002). Is there an increased risk of dying after depression? American Journal of Epidemiology, 156, 1043–1048.PubMedCrossRefGoogle Scholar
  25. 25.
    Glassman, A., & Shapiro, P. (1998). Depression and the course of coronary artery disease. The American Journal of Psychiatry, 155, 4–11.PubMedGoogle Scholar
  26. 26.
    Berg, A., Palomaki, H., Lehtihalmes, M., et al. (2003). Poststroke depression: An 18-month follow-up. Stroke, 34, 138–143.PubMedCrossRefGoogle Scholar
  27. 27.
    Whyte, E., Mulsant, B., Vanderbuilt, J., et al. (2004). Depression after stroke: A prospective epidemiological study. The Journal of the American Society for Geriatric Dentistry, 52, 774–778.CrossRefGoogle Scholar
  28. 28.
    Provinciali, L., & Coccia, M. (2002). Post-stroke and vascular depression: A critical review. Neurological Science, 22, 417–428.CrossRefGoogle Scholar
  29. 29.
    Kim, S., Kim, Y., Choi, N., et al. (2001). Suicidal ideation of patients in the acute stage of stroke. Journal of Korean Neuropsychiatric Association, 40, 243–252.Google Scholar
  30. 30.
    Gaete, J., & Bogousslavsky, J. (2008). Post-stroke depression. Expert Review of Neurotherapeutics, 8, 75–92.PubMedCrossRefGoogle Scholar
  31. 31.
    Robinson, R. (2005). Vascular depression and poststroke depression: Where do we go from here? The American Journal of Geriatric Psychiatry, 13, 85–87.PubMedGoogle Scholar
  32. 32.
    Robinson, R., Starr, L., Lipsey, J., et al. (1984). A two-year longitudinal study of post-stroke mood disorders: Dynamic changes in associated variables over the first six months of follow-­up. Stroke, 15, 510–517.PubMedCrossRefGoogle Scholar
  33. 33.
    Dieguez, S., Staub, F., Bruggimann, L., et al. (2004). Is poststroke depression a vascular depression? Journal of Neurological Sciences, 226, 53–58.CrossRefGoogle Scholar
  34. 34.
    Robinson, R., & Szetela, B. (1981). Mood change following left hemisphere brain injury. Annals of Neurology, 9, 447–453.PubMedCrossRefGoogle Scholar
  35. 35.
    Starkstein, S., Robinson, R., & Price, T. (1987). Comparison of cortical and subcortical lesions in the production of poststroke mood disorders. Brain, 110, 1045–1059.PubMedCrossRefGoogle Scholar
  36. 36.
    Spalletta, G., Bossu, P., Ciaramella, A., et al. (2006). The etiology of poststroke depression: A review of the literature and a new hypothesis involving inflammatory cytokines. Molecular Psychiatry, 11, 984–991.PubMedCrossRefGoogle Scholar
  37. 37.
    O’Brien, S. M., Scott, L. V., & Dinan, T. G. (2006). Antidepressant therapy and C-reactive protein levels. The British Journal of Psychiatry, 188, 449–452.PubMedCrossRefGoogle Scholar
  38. 38.
    Kohen, R., Cain, K. C., Mitchell, P. H., et al. (2008). Association of serotonin transporter gene polymorphisms with poststroke depression. Archives of General Psychiatry, 65, 1296–1302.PubMedCrossRefGoogle Scholar
  39. 39.
    Gainotti, G., Azzoni, A., & Marra, C. (1999). Frequency, phenomenology and anatomical-­clinical correlates of major post-stroke depression. The British Journal of Psychiatry, 175, 163–167.PubMedCrossRefGoogle Scholar
  40. 40.
    House, A. (1996). Depression associated with stroke. Journal of Neurology and Psychiatry, 8, 453–457.Google Scholar
  41. 41.
    Carson, A., MacHale, S., Allen, K., et al. (2000). Depression after stroke and lesion location: A systematic review. Lancet, 356, 122–126.PubMedCrossRefGoogle Scholar
  42. 42.
    Paradiso, S., Ohkubo, T., & Robinson, R. (1997). Vegetative and psychological symptoms associated with depressed mood over the first two years after stroke. International Journal of Psychiatry in Medicine, 27, 137–157.PubMedCrossRefGoogle Scholar
  43. 43.
    Fedoroff, J., Starkstein, S., Parikh, R., et al. (1991). Are depressive symptoms nonspecific in patients with acute stroke? The American Journal of Psychiatry, 148, 1172–1176.PubMedGoogle Scholar
  44. 44.
    Lipsey, J., Spencer, W., Rabins, P., et al. (1986). Phenomenological comparison of poststroke depression and functional depression. The American Journal of Psychiatry, 143, 527–529.PubMedGoogle Scholar
  45. 45.
    Hackett, M., & Anderson, C. (2005). Treatment options for post-stroke depression in the elderly. Aging Health, 1, 95–105.CrossRefGoogle Scholar
  46. 46.
    Singh, A., Black, S., Herrmann, N., et al. (2000). Functional and neuroanatomic correlations in post-stroke depression: The sunnybrook stroke study. Stroke, 31, 637–644.PubMedCrossRefGoogle Scholar
  47. 47.
    Murphy, E. (1982). Social origins of depression in old age. The British Journal of Psychiatry, 141, 134–142.CrossRefGoogle Scholar
  48. 48.
    Angeleri, F., Angeleri, V. A., Foschi, N., et al. (1993). The influence of depression, social activity, and family stress on functional outcome after stroke. Stroke, 24, 1478–1483.PubMedCrossRefGoogle Scholar
  49. 49.
    Starkstein, S. E., & Robinson, R. G. (1989). Affective disorders and cerebral vascular disease. The British Journal of Psychiatry, 154, 170–182.PubMedCrossRefGoogle Scholar
  50. 50.
    Starkstein, S. E., Robinson, R. G., Honig, M. A., et al. (1989). Mood changes after right-­hemisphere lesions. The British Journal of Psychiatry, 155, 79–85.PubMedCrossRefGoogle Scholar
  51. 51.
    Robinson, R. G. (2003). Poststroke depression: Prevalence, diagnosis, treatment, and disease progression. Biological Psychiatry, 54, 376–387.PubMedCrossRefGoogle Scholar
  52. 52.
    Aben, I., Verhey, F., Honig, A., et al. (2001). Research into the specificity of depression after stroke: A review on an unresolved issue. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 25, 671–690.CrossRefGoogle Scholar
  53. 53.
    Ouimet, M. A., Primeau, F., & Cole, M. G. (2001). Psychosocial risk factors in poststroke depression: A systematic review. Canadian Journal of Psychiatry, 46, 819–828.Google Scholar
  54. 54.
    Hackett, M., & Anderson, C. (2005). Predictors of depression after stroke: A systematic review of observational studies. Stroke, 36, 2296–2301.PubMedCrossRefGoogle Scholar
  55. 55.
    Andersen, G., Vestergaard, K., Ingemann-Nielsen, M., et al. (1995). Risk factors for post-­stroke depression. Acta Psychiatrica Scandinavica, 92, 193–198.PubMedCrossRefGoogle Scholar
  56. 56.
    Robinson, R., Starr, L. B., Kubos, K., et al. (1983). A two-year longitudinal study of ­post-­stroke mood disorders: Findings during the initial evaluation. Stroke, 14, 736–741.PubMedCrossRefGoogle Scholar
  57. 57.
    Berg, A., Palomaki, H., Lehtihalmes, M., et al. (2001). Poststroke depression in acute phase after stroke. Cerebrovascular Diseases, 12, 14–20.PubMedCrossRefGoogle Scholar
  58. 58.
    Starkstein, S., Robinson, R., & Price, T. (1988). Comparison of patients with and without poststroke major depression matched for size and location of lesion. Archives of General Psychiatry, 45, 247–252.PubMedCrossRefGoogle Scholar
  59. 59.
    Lokk, J., & Delbari, A. (2010). Management of depression in elderly stroke patients. Neuropsychiatric Disease and Treatment, 6, 539–549.PubMedCrossRefGoogle Scholar
  60. 60.
    Carod-Artal, F. (2007). Are mood disorder a stroke risk factor? Stroke, 38, 1–3.PubMedCrossRefGoogle Scholar
  61. 61.
    Beblo, T., & Driessen, M. (2002). No melancholia in poststroke depression? A phenomenologic comparison of primary and poststroke depression. Journal of Geriatric Psychiatry and Neurology, 15, 44–49.PubMedCrossRefGoogle Scholar
  62. 62.
    Robinson, R., Bolduc, P., & Price, T. (1987). Two-year longitudinal study of poststroke mood disorders: Diagnosis and outcome at one and two years. Stroke, 18, 837–843.PubMedCrossRefGoogle Scholar
  63. 63.
    Wilkinson, P., Wolfe, C., Warburton, F., et al. (1997). A long-term follow-up of stroke patients. Stroke, 28, 507–512.PubMedCrossRefGoogle Scholar
  64. 64.
    Sharpe, M., Hawton, K., House, A., et al. (2009). Mood disorders in long-term survivors of stroke: Associations with brain lesion location and volume. Psychological Medicine, 20, 815–828.CrossRefGoogle Scholar
  65. 65.
    Astrom, M., Adolfsson, R., & Asplund, K. (1993). Major depression in stroke patients. A 3-year longitudinal study. Stroke, 24, 976–982.PubMedCrossRefGoogle Scholar
  66. 66.
    Christensen, H., Jorm, A., Mackinnon, A., et al. (1999). Age differences in depression and anxiety symptoms: A structural equation modeling analysis of data from a general population sample. Psychological Medicine, 29, 325–339.PubMedCrossRefGoogle Scholar
  67. 67.
    Agrell, B., & Dehlin, O. (1989). Comparison of six depression rating scales in geriatric stroke patients. Stroke, 20, 1190–1194.PubMedCrossRefGoogle Scholar
  68. 68.
    Carod-Artal, F., Ferreira Coral, L., Trizotto, D., et al. (2009). Poststroke depression: Prevalence and determinants in Brazilian stroke patients. Cerebrovascular Diseases, 28, 157–165.PubMedCrossRefGoogle Scholar
  69. 69.
    Adshead, F., Cody, D., & Pitt, B. (1992). BASDEC: A novel screening instrument for depression in elderly medical inpatients. British Medical Journal, 305, 397.PubMedCrossRefGoogle Scholar
  70. 70.
    Gusev, E., & Bogolepova, A. (2009). Depressive disorders in stroke patients. Neuroscience and Behavioral Physiology, 39, 639–643.PubMedCrossRefGoogle Scholar
  71. 71.
    Strober, L. B., & Arnett, P. A. (2009). Assessment of depression in three medically ill, elderly populations: Alzheimer’s disease, Parkinson’s disease, and stroke. Clinical Neuropsychology, 23, 205–230.CrossRefGoogle Scholar
  72. 72.
    Laidlaw, K. (2007). Poststroke depression and CBT with older people. In G.-T. Dolores, M. S. Ann, & W. T. Lary (Eds.), Handbook of behavioral and cognitive therapies with older adults (pp. 233–248). New York: Springer.Google Scholar
  73. 73.
    Alexopoulos, G., Buckwalter, K., Olin, J., et al. (2002). Comorbidity of late life depression: An opportunity for research on mechanisms and treatment. Biological Psychiatry, 52, 543–558.PubMedCrossRefGoogle Scholar
  74. 74.
    Chen, Y., Guo, J. J., Zhan, S., et al. (2006). Treatment effects of antidepressants in patients with post-stroke depression: A meta-analysis. The Annals of Pharmacotherapy, 40, 2115–2122.PubMedCrossRefGoogle Scholar
  75. 75.
    Snow, V., Lascher, S., & Mottur-Pilson, C. (2000). Pharmacologic treatment of acute major depression and dysthymia: Clinical guideline, part 1. Annals of Internal Medicine, 132, 738–742.PubMedCrossRefGoogle Scholar
  76. 76.
    Turner-stokes, L., & Hassan, N. (2002). Depression after stroke: A review of the evidence base to inform the development of an integrated pathway. Part 1: Diagnosis, frequency and impact. Clinical Rehabilitation, 16, 231–247.PubMedCrossRefGoogle Scholar
  77. 77.
    Williams, L. S. (2005). Depression and stroke: Cause or consequence? Seminars in Neurology, 25, 396–409.PubMedCrossRefGoogle Scholar
  78. 78.
    Lazarus, L., Winemiller, D., Lingam, V., et al. (1992). Efficacy and side effects of ­methylphenidate for poststroke depression. The Journal of Clinical Psychiatry, 53, 447–449.PubMedGoogle Scholar
  79. 79.
    Paolucci, S. (2008). Epidemiology and treatment of post-stroke depression. Neuropsychiatric Disease and Treatment, 4, 145–154.PubMedCrossRefGoogle Scholar
  80. 80.
    Scogin, F., Welsh, D., Hanson, A., et al. (2006). Evidence-based psychotherapies for depression in older adults. Clinical Psychology: Science and Practice, 12, 222–237.CrossRefGoogle Scholar
  81. 81.
    Watkins, C., Auton, M., Deans, C., et al. (2007). Motivational interviewing early after acute stroke: A randomized, controlled trial. Stroke, 38, 1004–1009.PubMedCrossRefGoogle Scholar
  82. 82.
    Gallagher-Thompson, D., Steffen, A., Thompson, L., et al. (2008). Handbook of behavioral and cognitive therapies with older adults. New York: Springer.CrossRefGoogle Scholar
  83. 83.
    Gebretsadik, M., Jayaprabhu, S., & Grossberg, G. (2006). Mood disorders in the elderly. The Medical Clinics of North America, 90, 789–805.PubMedCrossRefGoogle Scholar
  84. 84.
    Kemp, B., Corgiat, M., & Gill, C. (1992). Effects of brief cognitive-behavioral group psychotherapy on older persons with and without disabling illness. Behavior, Health, & Aging, 2, 21–28.Google Scholar
  85. 85.
    Lincoln, N., & Flannaghan, T. (2003). Cognitive behavioral psychotherapy for depression following stroke: A randomized controlled trial. Stroke, 34, 111–115.PubMedCrossRefGoogle Scholar
  86. 86.
    Hackett, M., Anderson, C., & House, A. (2009). Interventions for treating depression after stroke. Stroke, 40, e487–e488.CrossRefGoogle Scholar
  87. 87.
    Australian, R. (2004). Australian and new Zealand clinical practice guidelines for the treatment of depression. The Australian and New Zealand Journal of Psychiatry, 38, 389–407.Google Scholar
  88. 88.
    Lai, S. M., Studenski, S., Richards, L., et al. (2006). Therapeutic exercise and depressive symptoms after stroke. Journal of American Geriatrics Society, 54, 240–247.CrossRefGoogle Scholar
  89. 89.
    Fiske, A., Wetherell, J., & Gatz, M. (2009). Depression in older adults. Annual Review of Clinical Psychology, 5, 363–389.PubMedCrossRefGoogle Scholar
  90. 90.
    Williams, L. S., Kroenke, K., Bakas, T., et al. (2007). Care management of post-stroke depression: A randomized, controlled trial. Stroke, 38, 998–1003.PubMedCrossRefGoogle Scholar
  91. 91.
    Turner-Stokes, L., Hassan, N., Pierce, K., et al. (2002). Managing depression in brain injury rehabilitation: The use of an integrated care pathway and preliminary report of response to sertraline. Clinical Rehabilitation, 16, 261–268.PubMedCrossRefGoogle Scholar
  92. 92.
    Beck, A. T., Ward, C. H., Mendelssohn, M. J., et al. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.PubMedCrossRefGoogle Scholar
  93. 93.
    Gordon, W. A., Hibbard, M. R., Egelko, S., et al. (1991). Issues in the diagnosis of post-stroke depression. Rehabilitation Psychology, 36, 71–87.CrossRefGoogle Scholar
  94. 94.
    Sutcliffe, L. M., & Lincoln, N. B. (1998). The assessment of depression in aphasic stroke patients: The development of the Stroke Aphasic Depression Questionnaire. Clinical Rehabilitation, 12, 506–513.PubMedCrossRefGoogle Scholar
  95. 95.
    Murray, G. B., Shea, V., & Conn, D. K. (1986). Electroconvulsive therapy for poststroke depression. The Journal of Clinical Psychiatry, 47, 258–260.PubMedGoogle Scholar
  96. 96.
    Currier, M., Murray, G., & Welch, C. (1992). Electroconvulsive therapy for poststroke depressed geriatric patients. The Journal of Neuropsychiatry and Clinical Neurosciences, 4, 140–144.PubMedGoogle Scholar
  97. 97.
    Robinson, R., Jorge, R., Moser, D., et al. (2008). Escitalopram and problem-solving therapy for prevention of poststroke depression: A randomized controlled trial. Journal of the American Medical Association, 299, 2391–2400.PubMedCrossRefGoogle Scholar
  98. 98.
    Hackett, M., Anderson, C., & House, A. (2005). Management of depression after stroke: A systematic review of pharmacological therapies. Stroke, 36, 1092–1097.CrossRefGoogle Scholar
  99. 99.
    Anderson, C. S., Hackett, M. L., & House, A. (2004). Interventions for preventing depression after stroke. Cochrane Database of Systematic Reviews, 2, 1–55.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of PsychiatryYonsei University College of MedicineSeodaemun-gu, SeoulKorea

Personalised recommendations