Despite progress in recognition, treatment and pathophysiology of poststroke depression, further research is required to fully address the issue, according to researchers.
“Poststroke depression has been recognized by psychiatrists for more than 100 years, but controlled systematic studies did not begin until the 1970s. Meta-analyses addressing almost all major clinical issues in the field have emerged because of the relatively small number of patients included in some stroke studies,” Robert G. Robinson, MD, of University of Iowa, Iowa City, and Ricardo E. Jorge, MD, of Baylor College of Medicine, Houston, wrote.
However, these meta-analyses merged patients with mood disorders with major depressive features with patients with scores above arbitrary cutoff points on depression rating scales. As a result, the analyses missed significant findings such as cognitive impairment associated with major but not minor depression, according to Robinson and Jorge.
The most recent meta-analysis of 61 cohorts including 25,488 patients, indicated 31% of patients developed depression within 5 years of stroke.
Antidepressants have been found to be effective for poststroke depression, according to recent meta-analyses and randomized controlled trials.
Early antidepressant treatment for prevention of poststroke depression improved physical and cognitive recovery from stroke and may increase survival up to 10 years following stroke, according to researchers.
In addition to treatment advances, there has been progress in understanding the pathophysiology of poststroke depression.
Research has indicated inflammatory processes may be associated with onset of some depressive symptoms. Further, genetic and epigenetic variations, white matter disease, cerebrovascular deregulation, altered neuroplasticity and changes in glutamate neurotransmission may be significant etiological factors.
In order to develop specific targeted treatments, more research is required to determine the mechanism of poststroke depression, according to Robinson and Jorge.
“Other urgent areas for future research include determining the mechanisms of increased mortality extending over at least 7 years following [poststroke depression] and elucidating the mechanism by which antidepressants enhance physical and cognitive recovery after stroke even in the absence of [poststroke depression]. The neurogenesis induced by [selective serotonin reuptake inhibitors] is a likely potential mechanism,” they concluded. – by Amanda Oldt
Disclosure: Robinson reports receiving compensation for participation in an advisory committee meeting sponsored by Avanir Pharmaceuticals; lecture honorarium from Xiang-Janssen Pharmaceuticals, research funding from the Senator Financial Group; serving as a consultant to Otsuka Pharmaceuticals; and receiving royalties from Cambridge University Press. Jorge reports receiving lecture honoraria from Janssen.