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      Post-Stroke Depression: A Review.

      1 , 1
      The American journal of psychiatry

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          Abstract

          Poststroke depression (PSD) 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. In order to build large databases, these meta-analyses have merged patients with rigorously assessed mood disorders with major depressive features with patients scoring above arbitrary cutoff points on depression rating scales, thus missing important findings such as cognitive impairment associated with major but not minor depression. Nevertheless, PSD occurs in a significant number of patients and constitutes an important complication of stroke, leading to greater disability as well as increased mortality. The most clinically important advances, however, have been in the treatment and prevention of PSD. Recent meta-analyses of randomized controlled trials for the treatment of PSD have demonstrated the efficacy of antidepressants. Similarly, randomized controlled trials for prevention of PSD have shown that antidepressants significantly decrease the incidence of PSD compared with placebo. Early antidepressant treatment of PSD appears to enhance both physical and cognitive recovery from stroke and might increase survival up to 10 years following stroke. There has also been progress in understanding the pathophysiology of PSD. Inflammatory processes might be associated with the onset of at least some depressive symptoms. In addition, genetic and epigenetic variations, white matter disease, cerebrovascular deregulation, altered neuroplasticity, and changes in glutamate neurotransmission might be relevant etiological factors. Further elucidation of the mechanism of PSD may ultimately lead to specific targeted treatments.

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          Author and article information

          Journal
          Am J Psychiatry
          The American journal of psychiatry
          1535-7228
          0002-953X
          Mar 1 2016
          : 173
          : 3
          Affiliations
          [1 ] From the Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, Iowa; the Michael E. DeBakey VA Medical Center, Houston; and the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston.
          Article
          10.1176/appi.ajp.2015.15030363
          26684921
          e202e5f3-b0ce-4ac3-b431-95358358df1b
          History

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