Post-stroke depression (II): Its differential diagnosis, complications and treatment

Aim. Post-stroke depression (PSD) is the most frequent neuropsychiatric condition after a stroke. We review the differential diagnosis of PSD, PSD complications and the different therapeutic approaches to PSD. Development. Differential diagnosis includes post-stroke fatigue and the pseudo-depressive manifestations of strategic infarctions (apathy, aprosody, lack of self psychic activation syndrome, pathological crying syndrome). Functional and cognitive complications of untreated PSD can be observed. Mortality in depressed stroke patients has been estimated between 3.5 and 10 times higher than in non depressed stroke patients; suicide ideation can be observed in 11.3% of stroke patients. Clinical trials controlled with placebo have shown the efficacy of fluoxetine, nortriptiline, trazodone and citalopram in the treatment of PSD. Other therapeutic approaches include cognitive and functional rehabilitation. Conclusion. PSD is a potentially treatable condition, infra-diagnosed, that has a negative effect on cognitive function, functional recovery and survival in stroke patients. State of the art of PSD pharmacological treatment are selective serotonin reuptake inhibitors. However there are no data showing neither superiority of one specific drug nor the best moment to start treatment.