The psychopharmacology of brain vascular disease/poststroke depression

Handb Clin Neurol. 2019:165:229-241. doi: 10.1016/B978-0-444-64012-3.00013-7.

Abstract

Poststroke depression (PSD) is a frequent complication and source of suffering among stroke survivors. Assessment of mood, suicidal ideation, and other neuropsychiatric disturbances that can co-occur or share similar features with depression are important aspects of clinical stroke care. Pharmacotherapy is the first-line treatment of PSD, with selective serotonin reuptake inhibitors (SSRIs) being agents of first choice. The evidence for SSRIs, newer generation antidepressants, and tricyclic antidepressants for PSD will be reviewed with consideration of their side effect profiles and use for other neuropsychiatric comorbidities. Additional therapeutic options, such as cognitive enhancing medications, brain stimulation, and psychotherapy can also be considered. Given the prevalence of PSD, preventive pharmacologic strategies may be effective alternatives. Ultimately, the choice of treatment will be determined by the type and severity of medical and psychiatric comorbidities as well as the preferences of the patient.

Keywords: Antidepressants; Depression; Poststroke depression; Stroke.

Publication types

  • Review

MeSH terms

  • Cerebrovascular Disorders / complications
  • Cerebrovascular Disorders / drug therapy*
  • Cerebrovascular Disorders / psychology*
  • Depression / drug therapy*
  • Depression / etiology
  • Depression / psychology*
  • Diagnosis, Differential
  • Humans
  • Psychopharmacology
  • Selective Serotonin Reuptake Inhibitors / therapeutic use
  • Stroke / complications
  • Stroke / drug therapy*
  • Stroke / psychology*

Substances

  • Serotonin Uptake Inhibitors