Post-stroke Depression

  • Bradleigh D. Hayhow
  • Simone Brockman
  • Sergio E. StarksteinEmail author


Post-stroke depression (PSD) is one of the most common neuropsychiatric sequelae of stroke. Cross-sectional studies of stroke survivors have demonstrated that about one-third of patients develop acute PSD and more than half suffer depression at some later point in their lives [1, 2]. PSD is strongly associated with a range of adverse clinical outcomes including increased length of hospital stay, higher risk of dependency, increased degree of neurological impairment, and increased patient mortality [3–6]. Therefore, there is significant potential benefit for effective prevention, diagnosis, and treatment of PSD.


Depressive Symptom Stroke Patient Antidepressant Medication Stroke Survivor Minor Depression 
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.
    Hackett ML, Yapa C, Parag V, Anderson CS. Frequency of depression after stroke: a systematic review of observational studies. Stroke. 2005;36(6):1330–40.PubMedCrossRefGoogle Scholar
  2. 2.
    Robinson R. The clinical neuropsychiatry of stroke. 2nd ed. Cambridge: Cambridge University Press; 2006.CrossRefGoogle Scholar
  3. 3.
    Feigin VL, Barker-Collo S, Parag V, Senior H, Lawes CM, Ratnasabapathy Y, et al. Auckland Stroke Outcomes Study. Part 1: Gender, stroke types, ethnicity, and functional outcomes 5 years poststroke. Neurology. 2010;75(18):1597–607.PubMedCrossRefGoogle Scholar
  4. 4.
    House A, Knapp P, Bamford J, Vail A. Mortality at 12 and 24 months after stroke may be associated with depressive symptoms at 1 month. Stroke. 2001;32(3):696–701.PubMedCrossRefGoogle Scholar
  5. 5.
    Ferri CP, Schoenborn C, Kalra L, Acosta D, Guerra M, Huang Y, et al. Prevalence of stroke and related burden among older people living in Latin America, India and China. J Neurol Neurosurg Psychiatry. 2011;82(10):1074–82.PubMedCrossRefGoogle Scholar
  6. 6.
    Morris PL, Robinson RG, Andrzejewski P, Samuels J, Price TR. Association of depression with 10-year poststroke mortality. Am J Psychiatry. 1993;150(1):124–9.PubMedGoogle Scholar
  7. 7.
    Hackett ML, Anderson CS, House A, Halteh C. Interventions for preventing depression after stroke. Cochrane Database Syst Rev. 2008;(3):CD003689.Google Scholar
  8. 8.
    Hackett ML, Anderson CS, House AO, Xia J. Interventions for treating depression after stroke. Stroke. 2009;40:487–8.Google Scholar
  9. 9.
    Price A, Rayner L, Okon-Rocha E, Evans A, Valsraj K, Higginson IJ, et al. Antidepressants for the treatment of depression in neurological disorders: a systematic review and meta-analysis of randomised controlled trials. J Neurol Neurosurg Psychiatry. 2011;82(8):914–23.PubMedCrossRefGoogle Scholar
  10. 10.
    Hackett ML, Anderson CS, House A, Xia J. Interventions for treating depression after stroke. Cochrane Database Syst Rev. 2008;(4):CD003437.Google Scholar
  11. 11.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th ed. Washington, DC: American Psychiatric Association; 2000. p. 943.Google Scholar
  12. 12.
    Folstein MF, Maiberger R, McHugh PR. Mood disorder as a specific complication of stroke. J Neurol Neurosurg Psychiatry. 1977;40(10):1018–20.PubMedCrossRefGoogle Scholar
  13. 13.
    Robinson RG, Szetela B. Mood change following left hemispheric brain injury. Ann Neurol. 1981;9(5):447–53.PubMedCrossRefGoogle Scholar
  14. 14.
    Whyte EM, Mulsant BH. Post stroke depression: epidemiology, pathophysiology, and biological treatment. Biol Psychiatry. 2002;52(3):253–64.PubMedCrossRefGoogle Scholar
  15. 15.
    Spalletta G, Ripa A, Caltagirone C. Symptom profile of DSM-IV major and minor depressive disorders in first-ever stroke patients. Am J Geriatr Psychiatry. 2005;13(2):108–15.PubMedGoogle Scholar
  16. 16.
    Robinson RG, Spalletta G. Poststroke depression: a review. Can J Psychiatry. 2010;55(6):341–9.PubMedGoogle Scholar
  17. 17.
    Beblo T, Driessen M. No melancholia in poststroke depression? A phenomenologic comparison of primary and poststroke depression. J Geriatr Psychiatry Neurol. 2002;15(1):44–9.PubMedCrossRefGoogle Scholar
  18. 18.
    House A. Mood disorders after stroke: a review of the evidence. Int J Geriatr Psychiatry. 1987;2(4):211–21.CrossRefGoogle Scholar
  19. 19.
    Williams LS, Brizendine EJ, Plue L, Bakas T, Tu W, Hendrie H, et al. Performance of the PHQ-9 as a screening tool for depression after stroke. Stroke. 2005;36(3):635–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Pedersen PM, Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS. Aphasia in acute stroke: incidence, determinants, and recovery. Ann Neurol. 1995;38(4):659–66.PubMedCrossRefGoogle Scholar
  21. 21.
    Wade DT, Hewer RL, David RM, Enderby PM. Aphasia after stroke: natural history and associated deficits. J Neurol Neurosurg Psychiatry. 1986;49(1):11–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Berthier ML. Poststroke aphasia: epidemiology, pathophysiology and treatment. Drugs Aging. 2005;22(2):163–82.PubMedCrossRefGoogle Scholar
  23. 23.
    Inatomi Y, Yonehara T, Omiya S, Hashimoto Y, Hirano T, Uchino M. Aphasia during the acute phase in ischemic stroke. Cerebrovasc Dis. 2008;25(4):316–23.PubMedCrossRefGoogle Scholar
  24. 24.
    Eastwood MR, Rifat SL, Nobbs H, Ruderman J. Mood disorder following cerebrovascular accident. Br J Psychiatry. 1989;154:195–200.PubMedCrossRefGoogle Scholar
  25. 25.
    Astrom M, Adolfsson R, Asplund K. Major depression in stroke patients. A 3-year longitudinal study. Stroke. 1993;24(7):976–82.PubMedCrossRefGoogle Scholar
  26. 26.
    Robinson RG, Starr LB, Kubos KL, Price TR. A two-year longitudinal study of post-stroke mood disorders: findings during the initial evaluation. Stroke. 1983;14(5):736–41.PubMedCrossRefGoogle Scholar
  27. 27.
    Parikh RM, Robinson RG, Lipsey JR, Starkstein SE, Fedoroff JP, Price TR. The impact of poststroke depression on recovery in activities of daily living over a 2-year follow-up. Arch Neurol. 1990;47(7):785–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Chemerinski E, Petracca G, Sabe L, Kremer J, Starkstein SE. The specificity of depressive symptoms in patients with Alzheimer’s disease. Am J Psychiatry. 2001;158(1):68–72.PubMedCrossRefGoogle Scholar
  29. 29.
    Reding MJ, Orto LA, Winter SW, Fortuna IM, Di Ponte P, McDowell FH. Antidepressant therapy after stroke. A double-blind trial. Arch Neurol. 1986;43(8):763–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Robinson RG, Schultz SK, Castillo C, Kopel T, Kosier JT, Newman RM, et al. Nortriptyline versus fluoxetine in the treatment of depression and in short-term recovery after stroke: a placebo-controlled, double-blind study. [see comment]. Am J Psychiatry. 2000;157(3):351–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Fruehwald S, Gatterbauer E, Rehak P, Baumhackl U. Early fluoxetine treatment of post-stroke depression–a three-month double-blind placebo-controlled study with an open-label long-term follow up. J Neurol. 2003;250(3):347–51.PubMedCrossRefGoogle Scholar
  32. 32.
    Narushima K, Robinson RG. The effect of early versus late antidepressant treatment on physical impairment associated with poststroke depression: is there a time-related therapeutic window? J Nerv Ment Dis. 2003;191(10):645–52.PubMedCrossRefGoogle Scholar
  33. 33.
    Mikami K, Jorge RE, Adams Jr HP, Davis PH, Leira EC, Jang M, et al. Effect of antidepressants on the course of disability following stroke. Am J Geriatr Psychiatry. 2011;19(12):1007–15.PubMedCrossRefGoogle Scholar
  34. 34.
    Morris PL, Robinson RG, Raphael B. Prevalence and course of depressive disorders in hospitalized stroke patients. Int J Psychiatry Med. 1990;20(4):349–64.PubMedCrossRefGoogle Scholar
  35. 35.
    Parikh RM, Robinson RG, Lipsey JR, Starkstein SE, Fedoroff JP, Price TR. The impact of poststroke depression on recovery in activities of daily living over a 2-year follow-up. Arch Neurol. 1990;47(7):785–9.PubMedCrossRefGoogle Scholar
  36. 36.
    Jorge RE, Robinson RG, Arndt S, Starkstein S. Mortality and poststroke depression: a placebo-controlled trial of antidepressants. Am J Psychiatry. 2003;160(10):1823–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Everson SA, Roberts RE, Goldberg DE, Kaplan GA. Depressive symptoms and increased risk of stroke mortality over a 29-year period. Arch Intern Med. 1998;158(10):1133–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Bolla-Wilson K, Robinson RG, Starkstein SE, Boston J, Price TR. Lateralization of dementia of depression in stroke patients. Am J Psychiatry. 1989;146(5):627–34.PubMedGoogle Scholar
  39. 39.
    Starkstein SE, Parikh RM, Robinson RG. Post-stroke depression and recovery after stroke. Lancet. 1987;1(8535):743.PubMedCrossRefGoogle Scholar
  40. 40.
    House A, Dennis M, Mogridge L, Warlow C, Hawton K, Jones L. Mood disorders in the year after first stroke. Br J Psychiatry. 1991;158:83–92.PubMedCrossRefGoogle Scholar
  41. 41.
    Spalletta G, Caltagirone C. Sertraline treatment of post-stroke major depression: an open study in patients with moderate to severe symptoms. Funct Neurol. 2003;18(4):227–32.PubMedGoogle Scholar
  42. 42.
    Kauhanen M, Korpelainen JT, Hiltunen P, Brusin E, Mononen H, Maatta R, et al. Poststroke depression correlates with cognitive impairment and neurological deficits. Stroke. 1999;30(9):1875–80.PubMedCrossRefGoogle Scholar
  43. 43.
    Robinson RG, Bolla-Wilson K, Kaplan E, Lipsey JR, Price TR. Depression influences intellectual impairment in stroke patients. Br J Psychiatry. 1986;148:541–7.PubMedCrossRefGoogle Scholar
  44. 44.
    Starkstein SE, Robinson RG, Price TR. Comparison of patients with and without poststroke major depression matched for size and location of lesion. Arch Gen Psychiatry. 1988;45(3):247–52.PubMedCrossRefGoogle Scholar
  45. 45.
    Kimura M, Robinson RG, Kosier JT. Treatment of cognitive impairment after poststroke depression: a double-blind treatment trial. Stroke. 2000;31:1482–6.PubMedCrossRefGoogle Scholar
  46. 46.
    Jorge RE, Starkstein SE, Robinson RG. Apathy following stroke. Can J Psychiatry. 2010;55(6):350–4.PubMedGoogle Scholar
  47. 47.
    Shimoda K, Robinson RG. The relationship between social impairment and recovery from stroke. Psychiatry. 1998;61(2):101–11.PubMedGoogle Scholar
  48. 48.
    Morris PL, Robinson RG, Raphael B, Bishop D. The relationship between the perception of social support and post-stroke depression in hospitalized patients. Psychiatry. 1991;54(3):306–16.PubMedGoogle Scholar
  49. 49.
    Robinson RG, Starr LB, Lipsey JR, Rao K, Price TR. A two-year longitudinal study of poststroke mood disorders. In-hospital prognostic factors associated with six-month outcome. J Nerv Ment Dis. 1985;173(4):221–6.PubMedCrossRefGoogle Scholar
  50. 50.
    Kotila M, Numminen H, Waltimo O, Kaste M. Depression after stroke: results of the FINNSTROKE Study. Stroke. 1998;29(2):368–72.PubMedCrossRefGoogle Scholar
  51. 51.
    Jia H, Damush TM, Qin H, Ried LD, Wang X, Young LJ, et al. The impact of poststroke depression on healthcare use by veterans with acute stroke. Stroke. 2006;37(11):2796–801.PubMedCrossRefGoogle Scholar
  52. 52.
    Andersen G, Vestergaard K, Ingemann-Nielsen M, Lauritzen L. Risk factors for post-stroke depression. Acta Psychiatr Scand. 1995;92(3):193–8.PubMedCrossRefGoogle Scholar
  53. 53.
    Dennis M, O’Rourke S, Lewis S, Sharpe M, Warlow C. A quantitative study of the emotional outcome of people caring for stroke survivors. Stroke. 1998;29(9):1867–72.PubMedCrossRefGoogle Scholar
  54. 54.
    Wade DT, Legh-Smith J, Hewer RA. Depressed mood after stroke. A community study of its frequency. Br J Psychiatry. 1987;151:200–5.PubMedCrossRefGoogle Scholar
  55. 55.
    Morris PL, Robinson RG, Andrezejewski P, Samuels J, Price TR. Association of depression with 10-year post-stroke mortality. Stroke. 1993;150:124–9.Google Scholar
  56. 56.
    Kishi Y, Kosier JT, Robinson RG. Suicidal plans in patients with acute stroke. J Nerv Ment Dis. 1996;184(5):274–80.PubMedCrossRefGoogle Scholar
  57. 57.
    Pohjasvaara T, Vataja R, Leppavuori A, Kaste M, Erkinjuntti T. Cognitive functions and depression as predictors of poor outcome 15 months after stroke. Cerebrovasc Dis. 2002;14(3–4):228–33.PubMedCrossRefGoogle Scholar
  58. 58.
    Chen Y, Guo JJ, Zhan S, Patel NC. Treatment effects of antidepressants in patients with post-stroke depression: a meta-analysis. Ann Pharmacother. 2006;40(12):2115–22.PubMedCrossRefGoogle Scholar
  59. 59.
    Masand P, Murray GB, Pickett P. Psychostimulants in post-stroke depression. J Neuropsychiatry Clin Neurosci. 1991;3(1):23–7.PubMedGoogle Scholar
  60. 60.
    Lazarus LW, Moberg PJ, Langsley PR, Lingam VR. Methylphenidate and nortriptyline in the treatment of poststroke depression: a retrospective comparison. Arch Phys Med Rehabil. 1994;75(4):403–6.PubMedCrossRefGoogle Scholar
  61. 61.
    Grade C, Redford B, Chrostowski J, Toussaint L, Blackwell B. Methylphenidate in early poststroke recovery: a double-blind, placebo-controlled study. Arch Phys Med Rehabil. 1998;79(9):1047–50.PubMedCrossRefGoogle Scholar
  62. 62.
    Williams LS, Kroenke K, Bakas T, Plue LD, Brizendine E, Tu W, et al. Care management of poststroke depression: a randomized, controlled trial. Stroke. 2007;38(3):998–1003.PubMedCrossRefGoogle Scholar
  63. 63.
    Joubert J, Joubert L, Reid C, Barton D, Cumming T, Mitchell P, et al. The positive effect of integrated care on depressive symptoms in stroke survivors. Cerebrovasc Dis. 2008;26(2):199–205.PubMedCrossRefGoogle Scholar
  64. 64.
    Lai SM, Studenski S, Richards L, Perera S, Reker D, Rigler S, et al. Therapeutic exercise and depressive symptoms after stroke. J Am Geriatr Soc. 2006;54(2):240–7.PubMedCrossRefGoogle Scholar
  65. 65.
    Jorge RE, Robinson RG, Tateno A, Narushima K, Acion L, Moser D, et al. Repetitive transcranial magnetic stimulation as treatment of poststroke depression: a preliminary study. Biol Psychiatry. 2004;55(4):398–405.PubMedCrossRefGoogle Scholar
  66. 66.
    Currier MB, Murray GB, Welch CC. Electroconvulsive therapy for post-stroke depressed geriatric patients. J Neuropsychiatry Clin Neurosci. 1992;4(2):140–4.PubMedGoogle Scholar
  67. 67.
    Murray GB, Shea V, Conn DK. Electroconvulsive therapy for poststroke depression. J Clin Psychiatry. 1986;47(5):258–60.PubMedGoogle Scholar
  68. 68.
    Palomaki H, Kaste M, Berg A, Lonnqvist R, Lonnqvist J, Lehtihalmes M, et al. Prevention of poststroke depression: 1 year randomised placebo controlled double blind trial of mianserin with 6 month follow up after therapy. J Neurol Neurosurg Psychiatry. 1999;66(4):490–4.PubMedCrossRefGoogle Scholar
  69. 69.
    Narushima K, Kosier JT, Robinson RG. Preventing poststroke depression: a 12-week double-blind randomized treatment trial and 21-month follow-up. J Nerv Ment Dis. 2002;190(5):296–303.PubMedCrossRefGoogle Scholar
  70. 70.
    Rasmussen A, Lunde M, Poulsen DL, Sorensen K, Qvitzau S, Bech P. A double-blind, placebo-controlled study of sertraline in the prevention of depression in stroke patients. Psychosomatics. 2003;44(3):216–21.PubMedCrossRefGoogle Scholar
  71. 71.
    Almeida OP, Waterreus A, Hankey GJ. Preventing depression after stroke: results from a randomized placebo-controlled trial. J Clin Psychiatry. 2006;67(7):1104–9.PubMedCrossRefGoogle Scholar
  72. 72.
    Robinson RG, Jorge RE, Moser DJ, Acion L, Solodkin A, Small SL, et al. Escitalopram and problem-solving therapy for prevention of poststroke depression: a randomized controlled trial. JAMA. 2008;299(20):2391–400.PubMedCrossRefGoogle Scholar
  73. 73.
    Anderson CS, Hackett ML, House AO. Interventions for preventing depression after stroke. Cochrane Database Syst Rev. 2004;(2):CD003689.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Bradleigh D. Hayhow
    • 1
  • Simone Brockman
    • 1
  • Sergio E. Starkstein
    • 1
    Email author
  1. 1.Department of PsychiatryFremantle HospitalFremantleAustralia

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