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Post stroke depression (PSD) is a depression that may occur after stroke, which has a significant impact on the healing process and overall quality of life of the affected persons.Studies have shown that poststroke depression is particularly associated with damage to the basal ganglia or the anterior brain region, including the hippocampal gyrus and the prefrontal cortex.Treatment of this condition generally includes selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants and cognitive behavioral therapy.
Symptoms and Signs
The symptoms of depression after stroke are the same as those of the main depression. The patient's symptoms and severity vary from person to person, but are usually manifested as depression and a decrease in interest in activities or a sense of happiness.
By definition, these symptoms include:
- Downy or sad
- Loss of happiness (no pleasure)
- Insomnia or lethargy
- Exhausted, exhausted or lack of energy
- Reduced appetite or excessive appetite
- Sense of guilt or self-loath
- Difficult to focus
- Psychiatric excitement or slowness
- Feeling despair, or having the idea of death or suicide
Miscity and Risk Factors
The incidence of post-stroke depression is reported to be between 18% and 33%, but this condition is often underestimated due to overlapping symptoms of stroke and depression.
Many risk factors can increase the likelihood of post-stroke depression, including:
- Female
- There was a history of mental illness in the past, especially depression before stroke
- Having experienced large or multiple strokes
- Stroke in the anterior or basal ganglia area
- Diffusing white matter damage
- Higher post-stroke disability
The location, size, overall severity of stroke and its impact on cognitive function can predict the possibility of post-stroke depression than other risk factors.
Pathological mechanism
The exact mechanism of post-stroke depression is not fully understood, and this condition is caused by the complex interaction of multiple factors such as neurochemistry, structure and inflammation.In particular, limbic system functions associated with major depression may be directly or indirectly affected by stroke.
Glutamate toxicity
Glutamate is an excitatory neurotransmitter substance. Excessive amounts can lead to neuronal death, aggravated impairment of mood regulation and reward pathways, especially in the prefrontal cortex, tonsils and hippocampal gyrus.
HPA axis offset
The hypothalamic-pituitary-adrenal (HPA) axis is responsible for regulating stress responses.HPA axis dysfunction is associated with elevated cortisol levels and chronic inflammation, which are all related to major depression.
Abnormal response to neurotrophic factor
The neurotrophic factor function in patients with depression after stroke is impaired, which affects the nerve growth and plasticity of the hippocampal gyrus and prefrontal lobes, which may lead to decreased emotional regulation and cognitive function.
The levels of monoamine nerve conducting substances are low
After stroke depression is usually associated with a decrease in levels of conducting substances such as serotonin, dopamine and norepinephrine, which will affect mood regulation, cognitive function and intracerebral reward system.
Screen and Diagnosis
Screen screening for poststroke depression should be a standard procedure for poststroke care, and tools such as the Hamilton Melancholy Score Scale (HDRS) and Patient Health Questionnaire-9 (PHQ-9) should be used.
The diagnosis is clinical, and any patient who has persistent depression symptoms after stroke can be diagnosed with poststroke depression.While these criteria may seem simple, the diagnosis can be challenging due to the overlap between stroke-related neurological symptoms and depression.
The difference between indifference after stroke
The difference between post-stroke depression and post-stroke apathy (PSA) is crucial.Apathy after stroke involves a reduction in goal-oriented behavior and a lack of spontaneous exercise or speech, but does not include symptoms related to depression such as depression, suicidal thoughts or guilt.
Treatment
The treatment strategies for post-stroke depression usually include the following:
- Medications: SSRIs, SNRIs and tricyclic antidepressants have shown effectiveness in the management of post-stroke depression.
- Cognitive Behavioral Therapy (CBT): Although CBT is beneficial for people with post-stroke depression, stroke-related symptoms such as language difficulties or physical limitations may hinder their participation.
Outlook
The mortality rate of patients with depression after stroke and baseline cognitive function is higher than that of patients with undepressed stroke.However, these consequences can be significantly improved by antidepressants such as SSRIs.Disability remains a challenge for many stroke patients, and post-stroke depression may aggravate medical problems and further affect disability.Faced with the challenge of post-stroke depression, we should think about: How to more effectively identify and treat the mental health problems of these patients to promote their recovery and quality of life?
