MEDLINE Abstracts on Post-stroke Depression.

Results of a MEDLINE Search by Ivan Goldberg, M.D.

1: Eur J Neurol 2001 Jul;8(4):315-9

Depression is an independent predictor of poor long-term functional outcome

Pohjasvaara T, Vataja R, Leppavuori A, Kaste M, Erkinjuntti T.

Memory Research Unit, Department of Clinical Neuroscience, Helsinki University
Central Hospital, Helsinki, Finland.

The influence of depression on the long-term outcome of stroke patients was
examined among 390 of 486 consecutive patients aged 55-85 years. They completed,
at 3 months after ischaemic stroke, a detailed medical, neurological, and
radiological stroke evaluation, structured measures of emotion (Beck’s
Depression Inventory, BDI), handicap (Rankin scale, RS), and assessment of
activities of daily living (Barthel Index, BI). Further RS and BI was evaluated
at 15-month follow-up from these 390 patients and BDI in 276 patients. A group
of 256 patients completed, in addition to the 15-month follow-up, a
comprehensive psychiatric evaluation, including the Present State Examination 3
months after stroke. The DSM-III-R criteria were used for diagnosis of the
depressive disorders. BDI identified depression (cut-off point > or = 10 for
depression) in 171 (43.9%) of 390 and in 123 (44.6%) of 276 patients at 3- and
15-month follow-up. DSM-III-R major depression was diagnosed in 66 (25.8%), and
minor depression in 32 (12.5%), of 256 patients 3 months after stroke. Patients
with BDI > or = 10, or major, but not minor, depression more often had poor
functional outcome (RS > II and BI < 17) at 15 months. Poor functional outcome
at 3 months also correlated with depression at 15 months. In logistic regression
analysis, depression at 3 months (Beck > or = 10) correlated with poor
functional outcome at 15 months (RS > II) (OR 2.5, 95% CI 1.6-3.8). More careful
examination and treatment of depression in stroke patients is emphasized.

PMID: 11422427 [PubMed – in process]


2: Curr Atheroscler Rep 2001 Jul;3(4):307-12

Post-stroke depression: an update.

Gawronski DW, Reding MJ.

Burke Rehabilitation Hospital, Weill Medical College of Cornell University, 785
Mamaroneck Avenue, White Plains, NY 10605, USA.

Those caring for stroke victims should be aware of new developments in our
understanding of depression following stroke, its diagnosis, prevalence,
pathophysiology, clinical features, and treatment. Appropriate diagnosis and
treatment will improve quality of life, self-care independence, and mortality.

PMID: 11389796 [PubMed – in process]


3: Hosp Med 2001 May;62(5):268-73

Post stroke depression.

Gall A.

Department of Rehabilitation Medicine, Woodend Hospital, Aberdeen AB15 6XS.

Depression following stroke is common. Although it is highlighted as an issue in
stroke guidelines, guidance on diagnosis or management is not given. This paper
presents the original research from a literature review of Medline and the
Cochrane Database on stroke and depression, and discusses some of the clinical
implications of the findings.

Publication Types:
Review literature

PMID: 11385885 [PubMed – indexed for MEDLINE]


4: Acta Psychiatr Scand 2001 Apr;103(4):287-93

Depression in stroke patients 7 years following stroke.

Dam H.

Department of Psychiatry, Rigshospitalet, Copenhagen, Denmark.

OBJECTIVE: To study the frequency of depression in stroke patients many years
following stroke, most previous studies having concentrated on the first few
years. METHOD: Participants of a previous study of post-stroke depression (99
stroke patients and 28 control subjects) were re-examined 7 years later.
Depression was diagnosed using research diagnostic criteria. The test battery
comprised the Mini Mental State Examination, the Raven Matrices A+B and Word
Pair Learning. Subjective experience of changes in memory, concentration, mood,
irritability and fatigue during the 7-year period was also examined. RESULTS:
Twenty per cent of the stroke patients fulfilled the criteria for major or minor
depression compared with 11% of the control subjects. No differences in
cognitive function were found between depressed and non-depressed stroke
patients. The stroke patients reported experiencing more lability of mood and
irritability during the 7-year period following stroke than the control
subjects. Depressed stroke patients experienced more impairment of concentration
and memory function than non-depressed stroke patients. CONCLUSION: Affective
symptoms are common among stroke patients 7 years following stroke.

PMID: 11328243 [PubMed – in process]


5: J Geriatr Psychiatry Neurol 2001 Spring;14(1):37-41

Feasibility and effectiveness of treatments for post-stroke depression in
elderly inpatients: systematic review.

Cole MG, Elie LM, McCusker J, Bellavance F, Mansour A.

Department of Psychiatry, St. Mary’s Hospital and McGill University, Montreal,

To determine the feasibility and effectiveness of antidepressive treatments for
post-stroke depression in elderly medical inpatients, MEDLINE was searched for
potentially relevant articles published from January 1987 to August 1997 using
the keywords “depression or depressive disorder” (exploded) and “aged.” Thirteen
reports met the following inclusion criteria: (1) published in English or
French; (2) minimum age criterion of 55 and over or mean age 65 and over; (3)
post-stroke subjects admitted to a medical, geriatric, or rehabilitation
service; (4) used accepted criteria for depression; (5) examined treatment(s)
for depression; and (6) reported outcomes as a depression diagnosis and/or
symptom level. Data were abstracted independently from each article by two
reviewers. The limited evidence suggests contraindications to treatment of 83%
of a group to receive a heterocyclic antidepressant compared with 11% of a group
to receive a selective serotonin reuptake inhibitor (SSRI); rates of
discontinuation and study completion are similar for heterocyclics, SSRIs and
psychostimulants. All of the treatments appear to be at least modestly effective
in the short term.

PMID: 11281315 [PubMed – in process]


6: Eur Neurol 2001;45(1):3-5

Comment on:
Eur Neurol. 2001;45(1):28-33

Post-stroke depression or fatigue.

Staub F, Bogousslavsky J.

Publication Types:

PMID: 11205620 [PubMed – indexed for MEDLINE]


7: Br J Psychiatry 2000 Mar;176:294-6

Erratum in:
Br J Psychiatry 2000 May;176:498

Comment on:
Br J Psychiatry. 1999 Aug;175:163-7

Psychological model of post-stroke major depression.

Ramasubbu S.

Publication Types:

PMID: 10755081 [PubMed – indexed for MEDLINE]


8: Cerebrovasc Dis 2000 Nov-Dec;10(6):455-61

Aphasia, depression, and non-verbal cognitive impairment in ischaemic stroke.

Kauhanen ML, Korpelainen JT, Hiltunen P, Maatta R, Mononen H, Brusin E,
Sotaniemi KA, Myllyla VV.

Department of Neurology, University of Oulu, Finland.

Aphasia, depression, and cognitive dysfunction are common consequences of
stroke, but knowledge of their interrelationship is limited. This 1-year
prospective study was designed to evaluate prevalence and course of post-stroke
aphasia and to study its psychiatric, neurological, and cognitive correlates. We
studied a series of 106 consecutive patients (46 women and 60 men, mean age 65.
8 years) with first-ever ischaemic brain infarction. The patients were
clinically examined, and presence and type of aphasia were evaluated during the
1st week after stroke and 3 and 12 months later. Psychiatric and
neuropsychological evaluations were performed 3 and 12 months after stroke.
Aphasia was diagnosed in 34% of the patients during the acute phase, and two
thirds of them remained so 12 months later. Seventy percent of the aphasic
patients fulfilled the DSM-III-R criteria of depression 3 months and 62% 12
months after stroke. The prevalence of major depression increased from 11 to 33%
during the 12-month follow-up period. The non-verbal neuropsychological test
performance in the aphasic patients was significantly inferior to that of the
patients with dominant hemisphere lesion without aphasia. One third of the
patients with ischaemic stroke suffer from communicative disorders which seem to
increase the risk of depression and non-verbal cognitive deficits. Although the
prevalence of depression in aphasic patients decreases in the long term, the
proportion of patients suffering from major depression seems to increase. We
emphasize the importance of the multidimensional evaluation of aphasic stroke
patients. Copyright 2000 S. Karger AG, Basel

PMID: 11070376 [PubMed – indexed for MEDLINE]


9: Am J Geriatr Psychiatry 2000 Fall;8(4):310-7

Does cognitive impairment cause post-stroke depression?

Murata Y, Kimura M, Robinson RG.

Department of Psychiatry, The University of Iowa College of Medicine, Iowa City,
IA 52242, USA.

Studies have demonstrated that poststroke depression is associated with
cognitive impairment, but have failed to show improvement in cognitive function
when mood improves. A consecutive series of patients with (n=41) or without
(n=135) major depression were evaluated for cognitive functioning during acute
hospitalization and either 3 or 6 months later. Patients with poststroke major
depression whose mood improved at follow-up had significantly greater recovery
in cognitive functioning than patients whose mood did not improve. Furthermore,
patients whose cognitive functioning improved at follow-up had significantly
greater improvement in mood than comparable patients whose cognitive function
did not improve, suggesting that poststroke major depression leads to cognitive
impairment and not vice versa. The failure of previous treatment studies to show
cognitive improvement in poststroke patients with depression was probably due to
the inclusion of patients with minor depression (not associated with cognitive
impairment) or the failure of patients with major depression to respond to

Publication Types:
Multicenter study

PMID: 11069271 [PubMed – indexed for MEDLINE]


10: Health News 2000 Sep;6(9):7

Post-stroke depression impedes recovery.

Publication Types:

PMID: 10997111 [PubMed – indexed for MEDLINE]


11: Br J Psychiatry 2000 Jan;176:94-5

Comment on:
Br J Psychiatry. 1999 Aug;175:163-7

Post-stroke depression.

Di Michele V, Bolino F.

Publication Types:

PMID: 10789340 [PubMed – indexed for MEDLINE]


12: Br J Clin Psychol 2000 Mar;39 ( Pt 1):53-65

Psychological management of post-stroke depression.

Kneebone II, Dunmore E.

Surrey Hampshire Borders NHS Trust, UK.

PURPOSE: To evaluate existing research literature on psychological interventions
to manage post-stroke depression (PSD). METHOD: First, the particular nature of
post-stroke depression (PSD) was established. Then, relevant published material
was identified through computerized literature searches (to May 1999) and via
the first author’s clinical experience in the area. This material was critically
reviewed against recommended standards for the empirical validation of treatment
effectiveness. RESULTS: Methodological limitations in existing research prevent
a conclusion as any one psychological intervention has empirical support for its
effectiveness. However, cognitive behaviour therapy in particular was identified
as worthy of further investigation. CONCLUSIONS: It is recommended that future
research investigates treatments for PSD appropriate for those with cognitive
impairment and communication difficulties, younger versus older stroke victims
and those in institutional settings. Studies should also consider the necessity
of specialist assessment strategies and allow for possible subtypes of PSD for
which psychological treatments might be differentially effective.

Publication Types:
Review, tutorial

PMID: 10789028 [PubMed – indexed for MEDLINE]


13: Br J Psychiatry 1999 Aug;175:163-7

Comment in:
Br J Psychiatry. 2000 Jan;176:94-5
Br J Psychiatry. 2000 Mar;176:294-5

Frequency, phenomenology and anatomical-clinical correlates of major post-stroke

Gainotti G, Azzoni A, Marra C.

Institute of Neurology, Catholic University of Rome, Italy.

BACKGROUND: The meaning of post-stroke depression is controversial. AIMS: To
investigate the hypothesis that major post-stroke depression (PSD) may be due to
organic factors (left frontal lesions) immediately after the stroke, but to
psychosocial factors in later stages. METHOD: We studied 153 consecutive stroke
patients, categorised on the basis of time elapsed since stroke, lesion location
and presence/absence of major PSD. Fifty-eight were examined in the first two
months following the stroke, 52 between two and four months, and 43 after four
months or more. The symptom profiles and anatomical-clinical correlates of major
PSD were studied in each subgroup. A group of 30 patients affected by a
functional form of major depression were also investigated. RESULTS: The symptom
profiles and anatomical-clinical correlates of major PSD were not different in
the acute and more chronic stages. Clear symptom differences were, however,
observed between major PSD and endogenous major depression. Motivated (reactive)
symptoms prevailed in the former, whereas unmotivated symptoms prevailed in the
latter. CONCLUSIONS: Our data are more consistent with a psychological than with
a neurological model of post-stroke depression.

PMID: 10627800 [PubMed – indexed for MEDLINE]


14: J Geriatr Psychiatry Neurol 1999 Winter;12(4):194-9

Screening for depressive symptoms among post-stroke outpatients in Eastern

Gesztelyi R, Fekete I, Kellermann M, Csiba L, Bereczki D.

Department of Neurology, University Medical School of Debrecen, Hungary.

Patients were consecutively enrolled in a cross-sectional study to determine the
severity of depressive symptoms and the rate of treated depression in a patient
population returning to a stroke outpatient service during a 10-week period for
a regular check-up examination after their stroke. Of the 143 stroke patients,
119 fulfilled the inclusion criteria. The 13-item Beck Depression Inventory was
used to screen for depressive symptoms. The score was at least 5 in 53%, 10 or
above in 26%, and 15 or above in 11% of patients. Severity of depressive
symptoms did not depend on gender, age, time elapsed from stroke, or the site of
the cerebral lesion. Most patients with considerable depressive symptoms did not
receive antidepressant medication at the time of the screening.

PMID: 10616867 [PubMed – indexed for MEDLINE]


15: Aust N Z J Psychiatry 1999 Aug;33(4):598-600

Post-stroke mania late in life involving the left hemisphere.

Fenn D, George K.

Aged Persons’ Mental Health Program, North-western Health, Sunshine Hospital, St
Albans, Victoria, Australia.

OBJECTIVE: Although post-stroke depression is well recognised, post-stroke mania
has rarely been reported and researched. Most reported cases have involved
lesions of the non-dominant hemisphere. We report a case of late-onset mania
following stroke with a lesion in the dominant hemisphere. CLINICAL PICTURE: A
78-year-old, right-handed man developed sudden cognitive deficits and manic
symptoms. Investigations revealed lesions in the dominant hemisphere. TREATMENT:
Pharmacological intervention was complicated by side effects. OUTCOME: His
symptoms resolved gradually over 2 months and he was back to normal in 4 months.
CONCLUSIONS: We would encourage further study in the area of post-stroke mania
and especially in relation to the site of the lesion in the brain.

PMID: 10483858 [PubMed – indexed for MEDLINE]


16: Fortschr Neurol Psychiatr 1999 Jul;67(7):327-35

[Vascular depression–a new concise concept]?

[Article in German]

Wetterling T.

Klinik fur Psychiatrie und Psychotherapie I, Johann Wolfgang Goethe-Universitat

Many studies pointed out that in the elderly depression is underdiagnosed,
probably due to the uncharacteristic psychopathologic symptoms. Often elder
people complain about somatic disorders and cognitive impairment, sometimes
covering the psychopathologic symptoms and hampering diagnostic classification.
Cerebrovascular disorders has been considered to be one major cause for
depressive mood in the elderly. In a recent paper Alexopoulos et al. (1997)
proposed the concept of vascular depression (VD) which is different from that of
post-stroke depression established by the group of Robinson and Starkstein. The
new concept is critically reviewed with regard of its clinical feasibility. In
contrast to the ICD-10 guidelines the vascular depression concept requires no
connection between the occurrence of psychopathology and of cerebrovascular
disorder. Therefore it appears to be more feasible in clinical practice.
However, a differentiation of vascular depression into two subtypes according to
the CT/MRI findings seems to be more promising: type I (macroangiopathy) is
similar to post-stroke-depression, while type II is characterized by
microangiopathy and its clinical description resembles that for vascular
depression of Alexopoulos et al. Up to now possible therapeutic consequences
have not been investigated. Moreover, the concept of vascular depression basing
only on two clinical studies needs further confirmation.

Publication Types:
Review, tutorial

PMID: 10443343 [PubMed – indexed for MEDLINE]


17: Clin Rehabil 1999 Jun;13(3):268-72

Post-stroke depression and functional outcome: a cohort study investigating the
influence of depression on functional recovery from stroke.

van de Weg FB, Kuik DJ, Lankhorst GJ.

Rehabilitation Centre, Amsterdam, The Netherlands.

OBJECTIVE: To investigate the influence of depression on functional recovery
after stroke. DESIGN: Multicentre cohort study of 85 patients admitted for
clinical rehabilitation. A two-stage case-finding procedure was used to identify
patients with depression. For the control group, consecutive nondepressed stroke
patients were enrolled. Patients were interviewed at 3-6 weeks and six months
after stroke onset. SETTING: Three rehabilitation centres in the vicinity of
Amsterdam. MAIN OUTCOME MEASURES: Functional outcome was determined by the
Functional Independence Measure (FIM) and the Rehabilitation Activities Profile
(RAP). RESULTS: The prevalence of depression (35%) was comparable with the
findings of earlier studies in other settings. Patients classified as depressed
according to DSM III R criteria (American Psychiatric Association Diagnostic and
statistical manual of mental disorders) had a significantly lower functional
score, both at onset and after follow-up (FIM and RAP). There was, however, no
significant difference in functional improvement between the depressed and the
nondepressed group. Mean functional improvement in the six patients treated with
antidepressants was 30% better than in the untreated (depressed) patients;
numbers were too small for the results to attain statistical significance.
Subset analysis showed a significantly higher outcome for nondepressed patients
for the FIM subitems personal care and transfers. However, functional
improvement was not significantly different for any of the subitems in depressed
versus nondepressed patients. CONCLUSION: Stroke patients with depression have
significantly lower functional scores both at onset and after six months. Our
results suggest under-recognition of post-stroke depression and a possible
beneficial effect of antidepressant medication in depressed stroke patients.
Further studies are required to determine the effect of antidepressants.

Publication Types:
Clinical trial
Controlled clinical trial
Multicenter study

PMID: 10392654 [PubMed – indexed for MEDLINE]


18: Fortschr Neurol Psychiatr 1999 Apr;67(4):155-62

[Depression after cerebrovascular injury. Review and differentiation from other
psychiatric complications].

[Article in German]

Fruhwald S, Loffler H, Baumhackl U.

Neurologische Abteilung, KH St. Polten.

In spite of the high incidence and prevalence of psychiatric complications after
cerebrovascular injury few results have remained uncontradicted so far. This
article focuses on the variety of psychiatric disorders after stroke reviewing
recent literature and concentrating in particular on Post-stroke Depression. The
prevalence of depressive disorders following stroke is assessed between 20 and
50%. Serious consequences for post-stroke depressed subjects are their increased
mortality, poor rehabilitation outcome and long-term affected quality of life.
Nevertheless, depressive disorders following stroke usually remain untreated. To
this date the effectiveness of only a few drugs has been studied in controlled
clinical trials (Nortriptylin, Citalopram, Imipramin, Mianserin). Besides
describing clinical presentation, epidemiology, pathogenesis and consequences of
post-stroke depressive disorders for the patient different authors’ statements
are listed and critically commented. Finally recommendations concerning
therapeutic intervention are mentioned.

Publication Types:
Review, tutorial

PMID: 10327311 [PubMed – indexed for MEDLINE]


19: Eur J Neurol 1999 May;6(3):309-12

Post-stroke depression and functional recovery in a population-based stroke
register. The Finnstroke study.

Kotila M, Numminen H, Waltimo O, Kaste M.

Department of Clinical Neurosciences, Helsinki University Central Hospital,
Haartmanninkatu 4, 00290 Helsinki, Finland.

Post-stroke depression and functional outcome were examined in a
population-based stroke register active in four different districts (total
population, 134 804) in Finland. Five hundred and ninety four first time strokes
were registered. Beck’s depression inventory (BDI), with ten as the cutoff point
for depression, was applied to 321 of 423 survivors after three months and to
311 of 390 survivors after 12 months. Functional outcome was measured with the
Barthel Index (BI) and the Rankin Scale (RS). One hundred and fifty one of 321
(47.0%) and 147 of 311 (47.3%) patients were depressed after three and 12
months, respectively. Depression at three months was associated with poor
functional outcome at the one-year follow-up (P = 0.001 for the BI and the RS).
On the other hand, poor functional outcome at three months was associated with
depression after one year (P = 0.004 and 0.002 for the BI and the RS,
respectively). Patients who were depressed at three months were more often in
institutional care between three and 12 months later than non-depressed patients
(P = 0.005). Post-stroke depression is associated with poor functional recovery
of patients. If depression were diagnosed and treated early, it might help
patients to recover more completely and/or faster, which could save community
healthcare resources by avoiding or shortening the time of institutional care or
reducing the need for home care. Copyright 1999 Lippincott Williams & Wilkins

PMID: 10210911 [PubMed – indexed for MEDLINE]


20: Brain Inj 1999 Feb;13(2):131-7

Major life events as risk factors for post-stroke depression.

Bush BA.

University of Alabama at Birmingham, Spain Rehabilitation Center, Department of
Physical Medicine and Rehabilitation 35233, USA.

Depression is a significant sequela of stroke which contributes to increased
morbidity and mortality in stroke survivors. Psychosocial stressors, such as
major life events, pose risk factors for developing depression in non-stroke
populations. This study evaluated major life events as a risk factor for
developing post-stroke depression (PSD) during the first year post-stroke. One
hundred and eleven patients who completed the Center for Epidemiological
Studies-Depression Scale at four time periods during the first year post-stroke
were assessed for PSD and asked if they had experienced a major life event in
the prior 6 months (other than the stroke). The subjects completed the
evaluations acutely (7-10 days), and at 3, 6, and 12 months post-stroke. At 6
months post-stroke patients were significantly more likely to be depressed if
they had a major life event in the prior 6 months (other than the stroke) than
if they had not, chi 2 (df = 1) = 4.83, p < 0.028, relative risk = 2.31, 95%
confidence interval 1.15-4.62. Life events pose significant risks for developing
PSD at 6 months post-stroke. Stroke patients need to be asked about these events
and treated for PSD.

PMID: 10079958 [PubMed – indexed for MEDLINE]


21: Int J Psychiatry Med 1997;27(2):137-57

Vegetative and psychological symptoms associated with depressed mood over the
first two years after stroke.

Paradiso S, Ohkubo T, Robinson RG.

University of Iowa College of Medicine, Iowa City, USA.

INTRODUCTION: In patients with acute physical illness, symptoms used in the
diagnosis of major depression such as sleep or appetite disturbance may be
nonspecific for depression. This study was undertaken to examine the association
of depressed mood with other depressive symptoms to determine which symptoms
were most useful in the accurate diagnosis of major depression after stroke.
METHODS: Using a structured mental status examination, 142 patients with acute
stroke were followed at three, six, twelve, and twenty-four months. RESULTS: The
median number of vegetative and psychological symptoms among patients with
depressed mood was more than three times the respective rates among nondepressed
patients at all time points over two years. Autonomic anxiety, morning
depression, subjective anergia, worrying, brooding, loss of interest,
hopelessness, and lack of self-confidence were significantly more frequent among
depressed patients than nondepressed patients throughout the entire two-year
period. Some symptoms such as anxious foreboding and loss of libido, as well as
self-depreciation, feelings of guilt, and irritability were no longer
significantly more common among depressed compared with nondepressed patients
after six months. Standard DSM-IV diagnostic criteria and modified DSM-IV
diagnostic criteria which included only specific symptoms of depression (i.e.,
symptoms which were significantly more frequent among depressed than
nondepressed mood patients) yielded similar frequencies of major depression
diagnosis. There were only a few patients (i.e., 2% to 3%) with depressive
symptoms without a depressed mood (perhaps “masked” depression). CONCLUSIONS:
Vegetative and psychological depressive symptoms are significantly more common
in depressed patients over the first two years after stroke and DSM-IV criteria
do not overdiagnose major depression even in this population with chronic
physical illness. The symptoms which characterize major depression appear to
change between the subacute and chronic post-stroke periods.

PMID: 9565720 [PubMed – indexed for MEDLINE]


22: J Clin Exp Neuropsychol 1997 Jun;19(3):340-56

The Post-Stroke Depression Rating Scale: a test specifically devised to
investigate affective disorders of stroke patients.

Gainotti G, Azzoni A, Razzano C, Lanzillotta M, Marra C, Gasparini F.

Servizio di Neuropsicologia, Universita Cattolica/Policlinico Gemelli, Roma,

Owing to the lack of instruments specifically constructed to study emotional and
affective disorders of stroke patients, the nature of post-stroke depression
(PSD) remains controversial. With this in mind, the authors constructed a new
scale, the Post-Stroke Depression Scale (PSDS) which takes into account a series
of symptoms and problems commonly observed in depressed stroke patients. The
PSDS and the Hamilton Depression Rating Scale (HDS) were administered to a group
of 124 patients, who had been classified, on the basis of DSM III-R diagnostic
criteria, in the following categories: No depression (n = 32); Minor PSD (n =
47); Major PSD (n = 45). Scores obtained by these stroke patients on the PSDS
and on the HDS were compared to those obtained on the same scales by 17
psychiatric patients also classified as major depression on the basis of DSM
III-R diagnostic criteria. An analysis of the symptomatological profiles clearly
showed that: (1) a continuum exists between the so-called “major” and “minor”
forms of PSD; (2) in both groups of depressed stroke patients the depressive
symptomatology seems due to the psychological reaction to the devastating
consequences of stroke, since the motivated aspects of depression prevailed in
depressed stroke patients, whereas the (biologically determined) unmotivated
aspects prevailed in patients with a functional form of major depression; and
(3) in stroke patients a DSM III-based diagnosis of major PSD could be in part
inflated by symptoms (such as apathy and vegetative disorders) that are typical
of major depression in a patient free from brain damage, but that could be due
to the brain lesion per se in a stroke patient.

Publication Types:
Clinical trial

PMID: 9268809 [PubMed – indexed for MEDLINE]


23: Med Health R I 1997 Jun;80(6):181-7

The diagnosis and treatment of post-stroke depression.

Harrington C, Salloway S.

Department of Neurology, Rhode Island Hospital, USA.

Depression is common after stroke but the diagnosis may be difficult. Anterior
and subcortical brain lesions increase the risk of depression. It is important
to make an accurate diagnosis of PSD as treatment may reduce morbidity.
Treatment should consist of family support, education and anti-depressant

Publication Types:
Review, tutorial

PMID: 9200897 [PubMed – indexed for MEDLINE]


24: Keio J Med 1997 Mar;46(1):25-6

The efficacy of antidepressants in post-stroke depression.

Shima S.

Division of Mental Science, Tokyo Keizai University, Japan.

The aim of the present study was to confirm the efficacy of antidepressants in
post-stroke depression and to identify the factors related to outcome. Subjects
consisted of 20 inpatients suffering from post-stroke in a rehabilitation
hospital. The subjects were treated with various antidepressants, mainly
imipramine, amitriptyline, and amoxapine. After 4 weeks of treatment, 13 showed
some improvement; significant improvement in 5, moderate improvement in 5, mild
improvement in 3 by a clinical global impression. Whereas all the patients aged
less than 65 yr were responders, only 3 of the 10 patients over 65 yr were
responders. All of the male patients, but only half of the female patients, were
responders. With regards to the presence of a spouse, 13 of the 16 patients with
a spouse, but none of 4 patients without, showed a response. No significant
correlation was found between the occurrence of each depressive symptom and
outcome. Thus, the responders were younger and had better social support in
comparison with the non-responders. This result implies that antidepressants are
effective for post-stroke depression.

Publication Types:
Clinical trial

PMID: 9095579 [PubMed – indexed for MEDLINE]


25: Int J Geriatr Psychiatry 1997 Feb;12(2):219-26

Risk factors for post-stroke depression.

Burvill P, Johnson G, Jamrozik K, Anderson C, Stewart-Wynne E.

University of Western Australia.

OBJECTIVE: To examine possible risk factors in post-stroke depression (PSD)
other than site of lesion in the brain DATA SOURCES: 191 first-ever stroke
patients were examined physically shortly after their stroke and examined
psychiatrically and physically 4 months post-stroke. SETTING: A geographically
defined segment of the metropolitan area of Perth, Western Australia, from which
all strokes over a course of 18 months were examined (the Perth Community Stroke
Study). MEASURES: Psychiatric Assessment Schedule, Mini Mental State
Examination, Barthel Index, Frenchay Activities Index, physical illness and
sociodemographic data were collected. Post-stroke depression (PSD) included both
major depression and minor depression (dysthymia without the 2-year time
stipulation) according to DSM-III (American Psychiatric Association) criteria.
Patients depressed at the time of the stroke were excluded. PATIENTS: 191
first-ever stroke patients, 111 M, 80 F, 28% had PSD, 17% major and 11% minor
depression. RESULTS: Significant associations with PSD at 4 months were major
functional impairment, living in a nursing home, being divorced and having a
high pre-stroke alcohol intake (M only). There was no significant association
with age, sex, social class, cognitive impairment or pre-stroke physical
illness. CONCLUSION: Results favoured the hypothesis that depression in an
unselected group of stroke patients is no more common, and of no more specific
aetiology, than it is among elderly patients with other physical illness.

PMID: 9097215 [PubMed – indexed for MEDLINE]


26: Acta Psychiatr Scand 1996 Oct;94(4):272-8

Dementia of depression or depression of dementia in stroke?

Andersen G, Vestergaard K, Riis JO, Ingeman-Nielsen M.

Department of Neurology, Aalborg Hospital, Denmark.

This study describes the correlation between changes in mood symptoms assessed
by the Hamilton Depression Rating Scale (HDRS) and intellectual impairment
assessed by the Brief Cognitive Rating Scale (BCRS) and Mattis Dementia Rating
Scale (MDRS) in 166 unselected 1-year survivors after stroke, in whom
post-stroke depression (PSD) has previously been described and validated. The
course of intellectual impairment associated with PSD was compared with the
course of intellectual impairment in non-PSD patients. In general, improvement
in mood symptoms was correlated with an improvement in intellectual function.
However, in 53 PSD patients improvement in intellectual performance was absent,
despite the fact that the patients reported being significantly less distressed
by dementia symptoms. Antidepressive medication did not lead to any improvement
in MDRS score. No evidence was found to support the hypothesis of ‘dementia of
depression’. To the contrary, the findings indicate ‘depression of dementia’.

PMID: 8911563 [PubMed – indexed for MEDLINE]


27: J Neuropsychiatry Clin Neurosci 1996 Spring;8(2):153-9

Lesion characteristics and depressed mood in the stroke data bank study.

Morris PL, Robinson RG, de Carvalho ML, Albert P, Wells JC, Samuels JF,
Eden-Fetzer D, Price TR.

Department of Psychiatry, University of Melbourne, Victoria, Australia.

This study examined the relationship between post-stroke lesion size and
location and depressed mood by using data from the multicenter National Stroke
Data Bank. For in patients with first-ever cerebral infarction, lesions were
characterized by location and size from CT scans. Forty-seven (24%) of the 193
patients studied were depressed. In the complete sample, neither lesion size nor
location was associated with depression. However, among patients with comparable
small-sized lesions (n = 124), depression was more frequent among those with
left hemisphere stroke than those with right hemisphere stroke (31% vs. 16%; P =
0.04). Among patients with larger lesions, brain edema was common and may have
obscured lateralized findings. Different biogenic amine neurotransmitter
responses to right and left hemisphere brain injury may underlie this mood

Publication Types:
Clinical trial
Multicenter study

PMID: 9081550 [PubMed – indexed for MEDLINE]


28: Drugs Aging 1995 Oct;7(4):298-309

Epidemiology and treatment of post-stroke depression.

Gustafson Y, Nilsson I, Mattsson M, Astrom M, Bucht G.

Department of Geriatric Medicine, Umea University, Sweden.

Depression is a common and serious complication after stroke. According to
epidemiological studies, at least 30% of stroke patients experience depression,
both early and late after stroke. However, in clinical practice only a minority
of the patients are diagnosed and even fewer are treated. There are several
studies confirming the magnitude of the problem but the main conclusion which
can be drawn from the few treatment studies published is that tricyclic
antidepressants cannot be recommended for the treatment of post-stroke
depression, mainly because of the high frequency of contraindications and
adverse effects. Until now there has only been 1 double-blind,
placebo-controlled treatment study from which some general conclusions can be
drawn. The study evaluated a selective serotonin reuptake inhibitor (citalopram)
and concluded that the drug was well tolerated and effective for the treatment
of post-stroke depression. However, when treatment was initiated very early,
both the treatment group and the placebo group improved equally during the first
7 weeks after stroke. This finding could indicate diagnosis difficulties during
the first few weeks after stroke. A recent study, although small, comparing the
combination of drugs with either noradrenergic (desipramine plus mianserin) or
noradrenergic and serotonergic effects (imipramine plus mianserin) for
post-stroke depression, indicated that drugs with the dual effect may be more
effective. Many more double-blind placebo-controlled treatment studies and
studies comparing the efficacy and adverse effects of various antidepressants in
patients with post-stroke depression need to be conducted. According to 3 small
studies, electroconvulsive therapy (ECT) seems to be quite well tolerated and
therefore ECT may also be considered in the treatment of post-stroke depression.
Future studies should also address the long term efficacy of treatment for
post-stroke depression.

Publication Types:
Review, tutorial

PMID: 8535057 [PubMed – indexed for MEDLINE]


29: Acta Psychiatr Scand 1995 Sep;92(3):193-8

Risk factors for post-stroke depression.

Andersen G, Vestergaard K, Ingemann-Nielsen M, Lauritzen L.

Department of Neurology, Aalborg Hospital, Denmark.

An unselected cohort of 285 stroke patients, median age 69 years, were studied
for correlation between potential risk factors and the 1-year incidence of
post-stroke depression (PSD). The following factors correlated significantly
with PSD: a history of previous stroke, a history of previous depression, female
gender, living alone and social distress prestroke. Further, social inactivity,
decrease in social activity, pathological crying and intellectual impairment at
1 month but not functional outcome correlated to PSD. A multivariate regression
analysis showed that intellectual impairment explained 42% of variance of mood
score. Major depression was unrelated to lesion location. We conclude that
etiology to PSD is a complex mixture of prestroke personal and social factors,
and stroke induced social, emotional and intellectual handicap.

PMID: 7484197 [PubMed – indexed for MEDLINE]


30: Ital J Neurol Sci 1995 May;16(4):209-16

Post-stroke depression: relationships with morphological damage and cognition
over time.

Iacoboni M, Padovani A, Di Piero V, Lenzi GL.

Dept. of Neurology, UCLA School of Medicine, USA.

The aim of the present study was to investigate the relationships between
post-stroke depression (PSD), lesion location and cognitive deficits after
stroke. We studied 20 patients within the first month after clinical onset (T1),
and one year later (T2). PSD was observed in 55% of patients at T1 and 35% of
patients at T2. At T1, depression was reliably correlated with dorsal lesions in
the right-hemisphere and anterior lesions in the left hemisphere. Lesion
location was no longer a significant factor determining PSD at T2. Changes in
PSD, from T1 to T2, were inversely correlated with the performances in cognitive
tests exploring the domains of attention, visuospatial learning, executive/motor
functions, and with the global composite cognitive score. Our data suggest that:
1) in the mix of influences that may produce PSD, lesion location is the main
factor determining mood changes after stroke in the first month; 2) PSD produces
deficits in attention, learning, and executive/motor functions, without
affecting language and other cognitive domains.

PMID: 7591672 [PubMed – indexed for MEDLINE]


31: Am J Phys Med Rehabil 1992 Aug;71(4):239-41

Methylphenidate in stroke patients with depression.

Johnson ML, Roberts MD, Ross AR, Witten CM.

Riverside Rehabilitation Institute, Newport News, Virginia.

The treatment of depression after stroke is a difficult clinical problem. Many
of the medications used to treat patients with depression in the general
population have significant potential side effects that are of particular
concern in elderly patients. We reviewed the records of ten patients with stroke
treated with methylphenidate for depression during an inpatient rehabilitation
program. Improvement was noted in seven patients. This suggests that
methylphenidate in the treatment of post-stroke depression merits further study.

Publication Types:
Clinical trial

PMID: 1642825 [PubMed – indexed for MEDLINE]


32: J Neuropsychiatry Clin Neurosci 1991 Winter;3(1):23-7

Psychostimulants in post-stroke depression.

Masand P, Murray GB, Pickett P.

Psychiatric Consult Service, Massachusetts General Hospital, Boston, USA.

The hospital charts of 17 patients with post-stroke depression who were treated
with either dextroamphetamine or methylphenidate during a 5-year period at the
Massachusetts General Hospital were examined. Eighty-two percent of the patients
showed improvement after psychostimulant treatment. Forty-seven percent of all
patients showed marked or moderate improvement in depressive symptoms. The
authors saw no significant differences in efficacy between the two
psychostimulants or across the diagnostic categories for depression. Patients
improved quickly, usually within the first 2 days of treatment. Adverse
reactions necessitating the termination of psychostimulant treatment occurred in
three patients. Anorexia was not observed as a side effect of either
dextroamphetamine or methylphenidate treatment. Psychostimulants appear to be a
safe and rapidly effective alternative to tricyclic antidepressants in
inpatients with post-stroke depression.

Publication Types:
Clinical trial

PMID: 7580168 [PubMed – indexed for MEDLINE]