Advertisement

Psychiatric Quarterly

, Volume 81, Issue 1, pp 73–79 | Cite as

Post Stroke Depression: Treatments and Complications in a Young Adult

  • Vincent F. CapaldiII
  • Gary H. Wynn
Case Report
  • 353 Downloads

Abstract

Post-stroke depression has been noted to be one of the most frequent complications of stroke with an estimated prevalence of as high as 80%. However, the incidence of stroke in the young is extremely low and evidence based therapy for this complication is quite limited. The case of a 28-year-old woman who experienced a basilar artery vasospasmic stroke resulting in anoxic brain injury to the midbrain and paramedian thalamus is presented, along with a literature review of psychiatric complications of this injury to include post-stroke depression (PSD). Therapeutic modalities such as TCAs, SSRIs, atypical antipsychotics and stimulant medications are also reviewed as these medications may aid in the treatment of such patients but may also contribute to psychiatric sequelae.

Keywords

Post stroke depression Brainstem stroke Migrainous vasospasm TCA SSRI Methylphenidate Aripiprazole Suicidality 

References

  1. 1.
    Marini C, Totaro R, De Santis F, Ciancarelli I, Baldassarre M, Carolei A: Stroke in young adults in the community-based L’aquila registry: Incidence and prognosis. Stroke 32:52–56, 2001PubMedGoogle Scholar
  2. 2.
    Yu W, Binder D, Foster-Barber A, Malek R, Smith WS, Higashida RT: Endovascular embolectomy of acute basilar artery occlusion. Neurology 61:1421–1423, 2003PubMedGoogle Scholar
  3. 3.
    Piechowski-Jozwiak B, Bogousslavsky J: Basilar occlusive disease: The descent of the feared foe? Archives of Neurology 61:471–472, 2004CrossRefPubMedGoogle Scholar
  4. 4.
    Caplan LR: Bilateral distal vertebral artery occlusion. Neurology 33:552–558, 1983PubMedGoogle Scholar
  5. 5.
    Morris PL, Robinson RG, Raphael B: Prevalence and course of depressive disorders in hospitalized stroke patients. International Journal of Psychiatry in Medicine 20:349–364, 1990PubMedGoogle Scholar
  6. 6.
    Castillo CS, Schultz SK, Robinson RG: Clinical correlates of early-onset and late-onset poststroke generalized anxiety. American Journal of Psychiatry 152:1174–1179, 1995PubMedGoogle Scholar
  7. 7.
    Chemerinski E, Levine SR: Neuropsychiatric disorders following vascular brain injury. Mount Sinai Journal of Medicine 73:1006–1014, 2006PubMedGoogle Scholar
  8. 8.
    Carota A, Berney A, Aybek S, et al.: A prospective study of predictors of poststroke depression. Neurology 64:428–433, 2005PubMedGoogle Scholar
  9. 9.
    Robinson RG: Vascular depression and poststroke depression: Where do we go from here? American Journal of Geriatric Psychiatry 13:85–87, 2005PubMedGoogle Scholar
  10. 10.
    Dieguez S, Staub F, Bruggimann L, Bogousslavsky J: Is poststroke depression a vascular depression? Journal of the Neurological Sciences 226:53–58, 2004CrossRefPubMedGoogle Scholar
  11. 11.
    Robinson RG, Lipsey JR, Bolla-Wilson K, et al.: Mood disorders in left-handed stroke patients. American Journal of Psychiatry 142:1424–1429, 1985PubMedGoogle Scholar
  12. 12.
    Carson AJ, MacHale S, Allen K, et al.: Depression after stroke and lesion location: A systematic review. Lancet 356:122–126, 2000CrossRefPubMedGoogle Scholar
  13. 13.
    Bozikas VP, Gold G, Kovari E, et al.: Pathological correlates of poststroke depression in elderly patients. American Journal of Geriatric Psychiatry 13:166–169, 2005PubMedGoogle Scholar
  14. 14.
    House A, Dennis M, Molyneux A, Warlow C, Hawton K: Emotionalism after stroke. BMJ 298:991–994, 1989CrossRefPubMedGoogle Scholar
  15. 15.
    Schiffer R, Pope LE: Review of pseudobulbar affect including a novel and potential therapy. Journal of Neuropsychiatry and Clinical Neurosciences 17:447–454, 2005PubMedGoogle Scholar
  16. 16.
    Ross ED, Stewart RS: Pathological display of affect in patients with depression and right frontal brain damage. An alternative mechanism. The Journal of Nervous and Mental Disease 175:165–172, 1987CrossRefPubMedGoogle Scholar
  17. 17.
    Okun MS, Riestra AR, Nadeau SE: Treatment of ballism and pseudobulbar affect with sertraline. Archives of Neurology 58:1682–1684, 2001CrossRefPubMedGoogle Scholar
  18. 18.
    Surridge D: An investigation into some psychiatric aspects of multiple sclerosis. British Journal of Psychiatry 115:749–764, 1969CrossRefPubMedGoogle Scholar
  19. 19.
    Udaka F, Yamao S, Nagata H, Nakamura S, Kameyama M: Pathologic laughing and crying treated with levodopa. Archives of Neurology 41:1095–1096, 1984PubMedGoogle Scholar
  20. 20.
    Wolf JK, Santana HB, Thorpy M: Treatment of “emotional incontinence” with levodopa. Neurology 29:1435–1436, 1979PubMedGoogle Scholar
  21. 21.
    Tortella FC, Pellicano M, Bowery NG: Dextromethorphan and neuromodulation: Old drug coughs up new activities. Trends in Pharmacological Sciences 10:501–507, 1989CrossRefPubMedGoogle Scholar
  22. 22.
    Whyte EM, Mulsant BH: Post stroke depression: Epidemiology, pathophysiology, and biological treatment. Biological Psychiatry 52:253–264, 2002CrossRefPubMedGoogle Scholar
  23. 23.
    Murray V, von Arbin M, Bartfai A, et al.: Double-blind comparison of sertraline and placebo in stroke patients with minor depression and less severe major depression. Journal of Clinical Psychiatry 66:708–716, 2005CrossRefPubMedGoogle Scholar
  24. 24.
    Rasmussen A, Lunde M, Poulsen DL, Sorensen K, Qvitzau S, Bech P: A double-blind, placebo-controlled study of sertraline in the prevention of depression in stroke patients. Psychosomatics 44:216–221, 2003CrossRefPubMedGoogle Scholar
  25. 25.
    Andersen G, Vestergaard K, Lauritzen L: Effective treatment of poststroke depression with the selective serotonin reuptake inhibitor citalopram. Stroke 25:1099–1104, 1994PubMedGoogle Scholar
  26. 26.
    Rampello L, Chiechio S, Nicoletti G, et al.: Prediction of the response to citalopram and reboxetine in post-stroke depressed patients. Psychopharmacology (Berlin) 173:73–76, 2004CrossRefGoogle Scholar
  27. 27.
    Robinson RG, Schultz SK, Castillo C, et al. Nortriptyline versus fluoxetine in the treatment of depression and in short-term recovery after stroke: A placebo-controlled, double-blind study. American Journal of Psychiatry 157:351–359, 2000CrossRefPubMedGoogle Scholar
  28. 28.
    Tharwani HM, Yerramsetty P, Mannelli P, Patkar A, Masand P: Recent advances in poststroke depression. Current Psychiatry Report 9:225–231, 2007CrossRefGoogle Scholar
  29. 29.
    Mamo D, Graff A, Mizrahi R, Shammi CM, Romeyer F, Kapur S: Differential effects of aripiprazole on D(2), 5-HT(2), and 5-HT(1A) receptor occupancy in patients with schizophrenia: A triple tracer PET study. American Journal of Psychiatry 164:1411–1413, 2007CrossRefPubMedGoogle Scholar
  30. 30.
    Douglas IJ, Smeeth L: Exposure to antipsychotics and risk of stroke: Self controlled case series study. BMJ 337:a1227, 2008CrossRefPubMedGoogle Scholar
  31. 31.
    Yan XB, Hou HL, Wu LM, Liu J, Zhou JN: Lithium regulates hippocampal neurogenesis by ERK pathway and facilitates recovery of spatial learning and memory in rats after transient global cerebral ischemia. Neuropharmacology 53:487–495, 2007CrossRefPubMedGoogle Scholar
  32. 32.
    Grade C, Redford B, Chrostowski J, Toussaint L, Blackwell B: Methylphenidate in early poststroke recovery: A double-blind, placebo-controlled study. Archives of Physical Medicine and Rehabilitation 79:1047–1050, 1998CrossRefPubMedGoogle Scholar
  33. 33.
    Annoni JM, Staub F, Bogousslavsky J, Brioschi A: Frequency, characterisation and therapies of fatigue after stroke. Neurological Sciences 29(Suppl 2):S244, 2008CrossRefPubMedGoogle Scholar
  34. 34.
    Qureshi A, Lee-Chiong T Jr: Medications and their effects on sleep. Medical Clinics of North America 88:751–766, 2004CrossRefPubMedGoogle Scholar
  35. 35.
    Walker-Batson D, Smith P, Curtis S, Unwin H, Greenlee R: Amphetamine paired with physical therapy accelerates motor recovery after stroke. further evidence. Stroke 26:2254–2259, 1995PubMedGoogle Scholar
  36. 36.
    Lazarus LW, Winemiller DR, Lingam VR, et al. Efficacy and side effects of methylphenidate for poststroke depression. Journal of Clinical Psychiatry 53:447–449, 1992PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Department of PsychiatryWalter Reed Army Medical CenterWashingtonUSA
  2. 2.Uniformed Services University of the Health Sciences F. Edward Hebert School of MedicineBethesdaUSA

Personalised recommendations