Poststroke anxiety and depression: epidemiology, mechanisms, and management strategies

Poststroke anxiety and depression (PSAD/PSAnx) are common and heterogeneous emotional disorders among stroke survivors, significantly impacting functional recovery, quality of life, and long term prognosis. Their pathogenesis is complex and multifactorial, involving neurobiological alterations, cognitive dysfunction, behavioral responses, and social environmental factors. Cognitive impairments, functional limitations, and insufficient social support can interact to amplify negative emotional responses, forming a vicious cycle of emotional disorders. Pharmacological interventions remain the cornerstone for moderate to severe cases, with selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) shown to improve mood, cognitive function, and some pain symptoms; individualized dosing and monitoring for adverse effects are essential. Nonpharmacological interventions, including structured rehabilitation, exercise, psychological therapies, and social support, can synergistically enhance neuroplasticity, promote emotional well-being, and improve adherence to rehabilitation. Current evidence is limited by heterogeneous assessment tools, short follow-up periods, and insufficient individualized interventions. Future research should focus on high quality randomized controlled trials, mechanism based stratified management, multimodal interventions, and digital or remote rehabilitation strategies to optimize emotional and functional recovery in stroke survivors. In conclusion, comprehensive interventions targeting PSAD/PSAnx should integrate biological, psychological, and social environmental factors, providing a scientific basis and clinical guidance for improving emotional health, functional restoration, and quality of life.