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Diagnostik und Therapie der Post-Stroke-Depression

Psychiatrische Komplikationen nach Schlaganfall

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DNP - Der Neurologe und Psychiater Aims and scope

Ein depressives Syndrom wird nach Schlaganfällen häufig beobachtet und kann sich schwerwiegend auf den gesamten Rehabilitationsverlauf primär-neurologischer Symptome auswirken. Dabei zeigt sich ein bidirektionaler Zusammenhang: Einerseits haben Patienten, die an einer depressiven Störung erkrankt sind, ein erhöhtes Risiko für zerebrovaskuläre Ereignisse, andererseits sind vermehrt depressive Syndrome nach Schlaganfall zu beobachten.

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Literatur

  1. Chen C et al. The interaction between neuropsychological and motor deficits in patients after stroke. Neurology 2013; 80:S27–34

    Article  PubMed  Google Scholar 

  2. Robinson RG et al. Poststroke depression: a review. Can J Psychiatry 2010; 55:341–349

    PubMed Central  PubMed  Google Scholar 

  3. Morris PL et al. Association of depression with 10-year poststroke mortality. Am J Psychiatry 1993; 150:124–129

    CAS  PubMed  Google Scholar 

  4. Bartoli F et al. Depression after stroke and risk of mortality: a systematic review and meta-analysis. Stroke Res Treat 2013; 2013:862978

    Article  PubMed Central  PubMed  Google Scholar 

  5. Goldstein LB et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42:517–584

    Article  PubMed  Google Scholar 

  6. Heuschmann P et al. Schlaganfallhäufigkeit und Versorgung von Schlaganfallpatienten in Deutschland. Für das Kompetenznetz Schlaganfall, die Deutsche Schlaganfall Gesellschaft sowie die Stiftung Deutsche Schlaganfall-Hilfe. Akt Neurol 2010; 37:333–340

    Article  Google Scholar 

  7. Loubinoux I et al. Post-stroke depression: mechanisms, translation and therapy. J Cell Mol Med 2012; 16:1961–1969

    Article  PubMed  Google Scholar 

  8. Ayerbe L et al. Natural history, predictors and outcomes of depression after stroke: systematic review and meta-analysis. Br J Psychiatry 2013; 202:14–21

    Article  PubMed  Google Scholar 

  9. Ayerbe L et al. The natural history of depression up to 15 years after stroke: the South London Stroke Register. Stroke 2013; 44:1105–1110

    Article  PubMed  Google Scholar 

  10. Pan A et al. Depression and risk of stroke morbidity and mortality: a meta-analysis and systematic review. JAMA 2011; 306:1241–1249

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Dong JY et al. Depression and risk of stroke: a meta-analysis of prospective studies. Stroke 2012; 43:32–37

    Article  PubMed  Google Scholar 

  12. Whooley MA Depression and cardiovascular disease: healing the broken-hearted. JAMA 2006; 295:2874–2881

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Otte C et al. Depression and 24-hour urinary cortisol in medical outpatients with coronary heart disease: The Heart and Soul Study. Biol Psychiatry 2004; 56:241–247

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. O’donnell MJ et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet 2010; 376:112–123

    Article  PubMed  Google Scholar 

  15. Neu P [Correlation of depression with stroke. Pathophysiological mechanisms]. Nervenarzt 2009; 80:772, 774-776, 778–780

    Article  CAS  PubMed  Google Scholar 

  16. Holsboer F et al. Stress hormone regulation: biological role and translation into therapy. Annu Rev Psychol 2010; 61:81–109, C101-111

    Article  PubMed  Google Scholar 

  17. Lederbogen F et al. Effect of mental and physical stress on platelet activation markers in depressed patients and healthy subjects: a pilot study. Psychiatry Res 2004; 127:55–64

    Article  CAS  PubMed  Google Scholar 

  18. Duivis HE et al. Depressive symptoms, health behaviors, and subsequent inflammation in patients with coronary heart disease: prospective findings from the heart and soul study. Am J Psychiatry 2011; 168:913–920

    Article  PubMed  Google Scholar 

  19. Miller AH et al. Inflammation and its discontents: the role of cytokines in the pathophysiology of major depression. Biol Psychiatry 2009; 65:732–741

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Otte C et al. Depressive symptoms and 24- hour urinary norepinephrine excretion levels in patients with coronary disease: findings from the Heart and Soul Study. Am J Psychiatry 2005; 162:2139–2145

    Article  PubMed Central  PubMed  Google Scholar 

  21. Schweiger U et al. Disturbed glucose disposal in patients with major depression; application of the glucose clamp technique. Psychosom Med 2008; 70:170–176

    Article  Google Scholar 

  22. El Husseini N et al. The role of neuroendocrine pathways in prognosis after stroke. Expert review of neurotherapeutics 2014; 14:217–232

    Article  CAS  PubMed  Google Scholar 

  23. Whooley MA et al. Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease. JAMA 2008; 300:2379–2388

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Win S et al. Depressive symptoms, physical inactivity and risk of cardiovascular mortality in older adults: the Cardiovascular Health Study. Heart 2011; 97:500–505

    Article  PubMed Central  PubMed  Google Scholar 

  25. Gehi A et al. Depression and medication adherence in outpatients with coronary heart disease: findings from the Heart and Soul Study. Arch Intern Med 2005; 165:2508–2513

    Article  PubMed Central  PubMed  Google Scholar 

  26. Thorndike AN et al. Depressive symptoms and smoking cessation after hospitalization for cardiovascular disease. Arch Intern Med 2008; 168:186–191

    Article  PubMed  Google Scholar 

  27. Carson AJ et al. Depression after stroke and lesion location: a systematic review. Lancet 2000; 356:122–126

    Article  CAS  PubMed  Google Scholar 

  28. Kronenberg G et al. Exofocal dopaminergic degeneration as antidepressant target in mouse model of poststroke depression. Biol Psychiatry 2012; 72:273–281

    Article  CAS  PubMed  Google Scholar 

  29. Santos M et al. The neuroanatomical model of post-stroke depression: towards a change of focus? J Neurol Sci 2009; 283:158–162

    Article  PubMed Central  PubMed  Google Scholar 

  30. Swardfager W et al. Interleukin-17 in poststroke neurodegeneration. Neurosci Biobehav Rev 2013; 37:436–447

    Article  CAS  PubMed  Google Scholar 

  31. Yang L et al. The serum interleukin-18 is a potential marker for development of poststroke depression. Neurological research 2010; 32:340–346

    Article  CAS  PubMed  Google Scholar 

  32. Fang J et al. Etiological mechanisms of post-stroke depression: a review. Neurological research 2009; 31:904–909

    Article  PubMed  Google Scholar 

  33. Dantzer R Cytokine-induced sickness behavior: mechanisms and implications. Ann N Y Acad Sci 2001; 933:222–234

    Article  CAS  PubMed  Google Scholar 

  34. Del Zoppo GJ et al. Microglial activation and matrix protease generation during focal cerebral ischemia. Stroke 2007; 38:646–651

    Article  PubMed  Google Scholar 

  35. Hellmann-Regen J et al. Accelerated degradation of retinoic acid by activated microglia. J Neuroimmunol 2013; 256:1–6

    Article  CAS  PubMed  Google Scholar 

  36. Yrjanheikki J et al. Tetracyclines inhibit microglial activation and are neuroprotective in global brain ischemia. Proc Natl Acad Sci U S A 1998; 95:15769–15774

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. Franco EC et al. Modulation of microglial activation enhances neuroprotection and functional recovery derived from bone marrow mononuclear cell transplantation after cortical ischemia. Neuroscience research 2012; 73:122–132

    Article  CAS  PubMed  Google Scholar 

  38. Li L et al. The effects of retinoic acid on the expression of neurogranin after experimental cerebral ischemia. Brain research 2008; 1226:234–240

    Article  CAS  PubMed  Google Scholar 

  39. Hackett ML et al. Management of depression after stroke: a systematic review of pharmacological therapies. Stroke 2005; 36:1098–1103

    Article  PubMed  Google Scholar 

  40. Boden-Albala B et al. Social isolation and outcomes post stroke. Neurology 2005; 64:1888–1892

    Article  CAS  PubMed  Google Scholar 

  41. Berg A et al. Assessment of depression after stroke: a comparison of different screening instruments. Stroke 2009; 40:523–529

    Article  PubMed  Google Scholar 

  42. Nolte CH et al. [Two simple questions to diagnose post-stroke depression]. Fortschritte der Neurologie-Psychiatrie 2006; 74:251–256

    Article  CAS  PubMed  Google Scholar 

  43. Whooley MA et al. Case-finding instruments for depression. Two questions are as good as many. Journal of general internal medicine 1997; 12:439–445

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  44. Suija K et al. Validation of the Whooley questions and the Beck Depression Inventory in older adults. Scandinavian journal of primary health care 2012; 30:259–264

    Article  PubMed Central  PubMed  Google Scholar 

  45. Allan LM et al. Long-term incidence of depression and predictors of depressive symptoms in older stroke survivors. Br J Psychiatry 2013; 203:453–460

    Article  PubMed  Google Scholar 

  46. De Man-Van Ginkel JM et al. In-hospital risk prediction for post-stroke depression: development and validation of the Post-stroke Depression Prediction Scale. Stroke 2013; 44:2441–2445

  47. Hackett ML et al. Interventions for treating depression after stroke. Cochrane Database Syst Rev 2008:CD003437

  48. Mitchell PH et al. Brief psychosocial-behavioral intervention with antidepressant reduces poststroke depression significantly more than usual care with antidepressant: living well with stroke: randomized, controlled trial. Stroke 2009; 40:3073–3078

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  49. Robinson RG et al. Escitalopram and problem- solving therapy for prevention of poststroke depression: a randomized controlled trial. JAMA 2008; 299:2391–2400

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  50. Harter M et al. [Evidence-based therapy of depression: S3 guidelines on unipolar depression]. Nervenarzt 2010; 81:1049–1068

    Article  CAS  PubMed  Google Scholar 

  51. Marcum ZA et al. FDA drug safety communications: a narrative review and clinical considerations for older adults. Am J Geriatr Pharmacother 2012; 10:264–271

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  52. Hackam DG et al. Selective serotonin reuptake inhibitors and brain hemorrhage: a meta-analysis. Neurology 2012; 79:1862–1865

    Article  CAS  PubMed  Google Scholar 

  53. Nelva A et al. [Hemorrhagic syndromes related to selective serotonin reuptake inhibitor (SSRI) antidepressants. Seven case reports and review of the literature]. Rev Med Interne 2000; 21:152–160

    Article  CAS  PubMed  Google Scholar 

  54. Targownik LE et al. Selective serotonin reuptake inhibitors are associated with a modest increase in the risk of upper gastrointestinal bleeding. Am J Gastroenterol 2009; 104:1475–1482

    Article  CAS  PubMed  Google Scholar 

  55. Leung M et al. Fluvoxamine-associated bleeding. Can J Psychiatry 1996; 41:604–605

    CAS  PubMed  Google Scholar 

  56. Andrade C et al. Serotonin reuptake inhibitor antidepressants and abnormal bleeding: a review for clinicians and a reconsideration of mechanisms. J Clin Psychiatry 2010; 71:1565–1575

    Article  PubMed  Google Scholar 

  57. Castro VM et al. Incident user cohort study of risk for gastrointestinal bleed and stroke in individuals with major depressive disorder treated with antidepressants. BMJ open 2012; 2:e000544

    Article  PubMed Central  PubMed  Google Scholar 

  58. De Abajo FJ et al. Antidepressants and risk of upper gastrointestinal bleeding. Basic Clin Pharmacol Toxicol 2006; 98:304–310

    Article  PubMed  Google Scholar 

  59. Lee YC et al. Antidepressant use and the risk of upper gastrointestinal bleeding in psychiatric patients: a nationwide cohort study in Taiwan. J Clin Psychopharmacol 2012; 32:518–524

    Article  CAS  PubMed  Google Scholar 

  60. Niedermaier N et al. Prevention and treatment of poststroke depression with mirtazapine in patients with acute stroke. J Clin Psychiatry 2004; 65:1619–1623

    Article  CAS  PubMed  Google Scholar 

  61. Andrade C Drug interactions in the treatment of depression in patients with ischemic heart disease. J Clin Psychiatry 2012; 73:e1475–1477

    Article  PubMed  Google Scholar 

  62. Mead GE et al. Selective serotonin reuptake inhibitors (SSRIs) for stroke recovery. Cochrane Database Syst Rev 2012; 11:CD009286

    PubMed  Google Scholar 

  63. Chollet F et al. Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial. Lancet Neurol 2011; 10:123-130

  64. Pariente J et al. Fluoxetine modulates motor performance and cerebral activation of patients recovering from stroke. Ann Neurol 2001; 50:718–729

    Article  CAS  PubMed  Google Scholar 

  65. Hackett ML et al. Interventions for preventing depression after stroke. Cochrane Database Syst Rev 2008:CD003689

    Google Scholar 

  66. Salter KL et al. Prevention of Poststroke Depression: Does Prophylactic Pharmacotherapy Work? J Stroke Cerebrovasc Dis 2012

  67. Dam M et al. Effects of fluoxetine and maprotiline on functional recovery in poststroke hemiplegic patients undergoing rehabilitation therapy. Stroke 1996; 27:1211–1214

    Article  CAS  PubMed  Google Scholar 

  68. Li WL et al. Chronic fluoxetine treatment improves ischemia-induced spatial cognitive deficits through increasing hippocampal neurogenesis after stroke. Journal of neuroscience research 2009; 87:112–122

    Article  CAS  PubMed  Google Scholar 

  69. Lim CM et al. Fluoxetine affords robust neuroprotection in the postischemic brain via its anti-inflammatory effect. Journal of neuroscience research 2009; 87:1037–1045

    Article  CAS  PubMed  Google Scholar 

  70. Windle V et al. Fluoxetine and recovery of motor function after focal ischemia in rats. Brain research 2005; 1044:25–32

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Christian Otte.

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Interessenkonflikt

Prof. Christian Otte erklärt Forschungsförderung: Roche, Beratungstätigkeit: Lundbeck und Vortragshonorare: Lundbeck, Servier. Prof. Matthias Endres erklärt Forschungsförderung: AstraZeneca, Roche, Sanofi, Beratungstätigkeit: Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, MSD, Pfizer, Sanofi und Vortragshonorare: Astra Zeneca, Bayer, Boston Scientific, Bristol-Myers Squibb, Boehringer- Ingelheim, Ever, Glaxo Smith Kline, MSD, Novartis, Pfizer, Sanofi.

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Hellmann-Regen, J., Regen, F., Heuser, I. et al. Diagnostik und Therapie der Post-Stroke-Depression. DNP 15, 61–68 (2014). https://doi.org/10.1007/s15202-014-0753-6

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