Diagnosis and etiology of poststroke depression: A review

Following an acute stroke, patients often encounter a range of impairments affecting their physical, cognitive, verbal, and social capabilities. Poststroke depression (PSD) has been identified as a significant consequence of stroke and serves as a crucial predictor of patient outcomes. The diagnosis of PSD presents a challenge, as the physical manifestations following a stroke can overlap with certain depressive symptoms, leading to a potential underdiagnosis of this condition. This review employs a narrative approach to synthesize diverse findings within this domain. PSD is categorized as an organic mood disorder, and a more accurate diagnosis may be achieved by considering the location of the stroke, the patient's specific symptoms, and the timeline of depressive symptom onset. Notably, if depressive symptoms emerge at more than one year poststroke, the likelihood of PSD diminishes. The etiology of PSD is currently understood to stem from a combination of physiological and psychosocial factors, as well as their interactions. Several mechanisms associated with PSD have been identified, including inflammation, dysregulation of the hypothalamic-pituitary-adrenal axis, oxidative stress, autophagy, apoptosis, abnormal neurotrophic responses, glutamate-mediated excitotoxicity, dysfunction within brain networks, reduced monoamine levels, locations of brain lesions, and psychosocial influences. This review also outlines potential directions for future research.