Depression after stroke and lesion location: a systematic review

Area of Science:

• Neuroscience
• Psychiatry
• Clinical Neurology

Background:

• Conflicting evidence exists regarding the influence of brain lesion location on post-stroke depression risk.
• Previous studies have not definitively established whether left-hemisphere or left anterior lesions are more strongly associated with depression after stroke.

Purpose of the Study:

• To systematically review and examine the hypothesis that depression risk after stroke is influenced by lesion location.
• To investigate if left-hemisphere strokes or left anterior brain lesions are more commonly associated with depression compared to other regions.

Main Methods:

• A comprehensive computer-aided and hand-search of multiple databases (MEDLINE, BIDS ISI, PsychLit) was conducted.
• Eligible reports on the association between stroke lesion location and depression were systematically reviewed by two independent investigators.
• Fixed-effects and random-effects meta-analyses were performed on the collected data.

Main Results:

• Out of 143 identified reports, 48 were included; however, not all contained original data.
• Only two original data reports supported the hypotheses, while seven clearly did not.
• Meta-analysis showed no significant difference in depression risk between left-hemisphere and right-hemisphere strokes (RR 0.95, 95% CI 0.83-1.10).
• No significant difference was found for depression risk with left anterior lesions compared to other brain areas (RR 1.17, 95% CI 0.87-1.62).
• Analyses restricted to high-quality studies, major depressive disorder, or stratified by time post-stroke did not alter these findings.

Conclusions:

• This systematic review provides no support for the hypothesis that the location of a brain lesion influences the risk of depression after stroke.
• The findings suggest that lesion location is not a significant predictor of post-stroke depression.