Management of poststroke depression in older people

Depression is a common and under-recognized cause of suffering after stroke. Poststroke depression (PSD) is associated with poorer stroke recovery and increased mortality. Much published research focuses on controversies about demographic and lesion-related associations with PSD and the extent to which it is different from primary depressive illness without stroke. Methodological and population differences across studies account for at least part of the inconsistent research findings about PSD. Rates of treatment for PSD appear to be extremely low. Surprisingly little evidence is available about the effectiveness of various treatments for PSD, and randomized controlled clinical trials are needed. This article summarizes epidemiologic data about PSD, highlights stroke-related and demographic features that increase risk, and reviews the literature on treatment.