A Two-Phase Pathogenetic Model of Depression after Stroke

Depression is among the major long-term complications of cerebral stroke. Occurring in about 30% of all stroke survivors, 'poststroke depression' (PSD) is known to be associated with prolonged recovery, reduced quality of life, and increased mortality. Research over the past 25 years has enlarged our knowledge about organic and psychosocial risk factors, but their interaction is still unclear. In this paper, we start by reviewing and discussing pathogenetic PSD models that were proposed in the 1980s and 1990s. Based on these earlier approaches and on longitudinal research published since that time, a biphasic model is proposed that reflects the current knowledge on the emergence of PSD. The model integrates premorbid, stroke-related and psychosocial risk factors contributing to the emergence of PSD within the first 2 years after stroke. The distinction between 'reactive' and 'organic' PSD has been dropped, and groups of well-documented predictors are recommended for future research. Finally, we will outline possible implications of the model for prevention and therapy.