The advances of post-stroke depression: 2021 update

Area of Science:

• Neuroscience
• Psychiatry
• Rehabilitation Medicine

Background:

• Post-stroke depression (PSD) is a common and severe complication following stroke.
• Affecting up to one-third of stroke survivors, PSD significantly impairs functional recovery and quality of life.
• PSD is strongly linked to increased mortality rates among stroke patients.

Purpose of the Study:

• To provide a comprehensive understanding of PSD by reviewing recent and classic literature.
• To integrate current knowledge on the incidence, contributing factors, diagnosis, and mechanisms of PSD.
• To identify existing gaps in the understanding and treatment of PSD.

Main Methods:

• Systematic review of published papers and classic articles on post-stroke depression.
• Analysis of studies reporting on PSD incidence, risk factors, diagnostic criteria, and proposed mechanisms.
• Synthesis of information on current therapeutic approaches, including pharmacotherapy and psychological interventions.

Main Results:

• The incidence of PSD within two years post-stroke ranges from 11% to 41%.
• Key contributing factors include a history of depression, stroke severity, and lesion location.
• Proposed mechanisms involve HPA axis dysregulation, inflammation, altered monoamine levels, excitotoxicity, and neurotrophic responses, though a unified explanation is lacking.

Conclusions:

• Despite advances, the precise mechanisms underlying PSD remain unclear.
• Current diagnostic approaches rely on DSM guidelines and depression scales.
• Effective treatment strategies involve pharmacotherapy and psychological therapies, but further research is needed to address unresolved issues and improve patient outcomes.