Depression is a very frequent complication of stroke. A number of studies indicate that there are many sociodemographic and clinical variables which complicate the predictability of the outcome of stroke when this is associated with depressive comorbidity. These variables are laterality of stroke, lesion location, time elapsed from acute stroke, previous personal or family psychiatric disturbances, gender, age, aphasia and physical impairment. As a consequence, post-stroke depression (PSD) has not yet been fully defined as a nosographic entity independent of functional depression. However, even though there is not a consensus among the various studies, at this point in research the two forms of DSM-IV major and minor depression seem to be quite valid diagnostic categories for different types of PSD. Another problem which has been widely debated is that of PSD neurobiology. As far as this is concerned, there is evidence, although it is not consensual, that left hemispheric stroke can increase the risk of developing depressive disturbances while lesions in the right hemisphere can increase the development of hyperactivity-indifference. Moreover, the functional impairment of ascendant serotonergic and noradrenergic pathways, which from the rafe and the locus coeruleus extend first to the prefrontal cortex and then to various posterior areas, would seem to be implicated in the pathogenesis of PSD. Taking into consideration the high prevalence and the negative influence of depressive comorbidity on the quality of life and rehabilitation therapy of stroke patients, clinicians should carefully observe all patients with this pathology in order to identify PSD symptoms precociously and use efficacious and tolerable antidepressant drugs such as serotonergic and noradrenergic agents.
|Translated title of the contribution||New perspectives on neurobiology and treatment of post-stroke depression|
|Number of pages||8|
|Journal||Nuova Rivista di Neurologia|
|Publication status||Published - 2002|
ASJC Scopus subject areas
- Clinical Neurology