Treatment of Post-Stroke Depression

We present the reader with the most recent evidence to support pharmacological, psychosocial, and neuromodulation interventions in PSD. We also discuss the relevance of using antidepressants and psychotherapy to prevent PSD and discuss evidence that antidepressant treatment may reduce mortality after stroke.Recent findingsNeuroinflammation and decrease neurogenesis and plasticity may play an important role in the mechanism of PSD. The strongest predictors of PSD are stroke severity, early physical disability, and severity of loss of functioning. Nevertheless, populations at risk for PSD are yet to be identified. Recent meta-analysis examined the efficacy of pharmacotherapy and psychotherapy. There is consensus that antidepressants such as escitalopram and paroxetine produce a significantly greater response and remission rate of PSD than placebo. Randomised controlled trials (RCTs) using psychotherapy are fewer, but recent meta-analysis tend to suggest efficacy for this treatment modality. Neuromodulation using repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS), as well as novel psychosocial interventions are potentially useful treatments in need of further research.SummaryPharmacological therapy with antidepressants and psychotherapy should be considered as first line of treatment for PSD. The most effective antidepressants are the selective serotonin reuptake inhibitors escitalopram and paroxetine, whereas cognitive behaviou...
Source: Current Treatment Options in Neurology - Category: Neurology Source Type: research

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Stroke is the leading cause of both serious and long-term disability and the fifth leading cause of death in the United States.1,2 Post-stroke depression (PSD) afflicts approximately one-fourth of stroke survivors and increases the likelihood of persistent disability.3-6 Prompt identification and treatment of PSD can improve affective symptoms and stroke related disability.7,8
Source: The American Journal of Geriatric Psychiatry - Category: Geriatrics Authors: Tags: Regular Research Article Source Type: research
Conclusions: A structured and targeted caregiver intervention is urgently needed to relieve caregivers' burden and related psychological comorbidities in an Indian setup.
Source: Annals of Indian Academy of Neurology - Category: Neurology Authors: Source Type: research
The dangers of alcohol begin at the first sip of the first drink. Although most responsible drinking habits shouldn’t be cause for major concern, everyone who drinks runs the risk of encountering the negative effects of alcohol. The Dietary Guidelines for Americans defines moderate drinking as up to 1 drink per day for women and up to 2 drinks per day for men.  A single drink is considered as: 12 ounces of beer (5% alcohol content) 8 ounces of malt liquor (7% alcohol content) 5 ounces of wine (12% alcohol content) 1.5 ounces of 80-proof (40% alcohol content) distilled spirits or liquor (e.g., gin, rum, vodka, ...
Source: Cliffside Malibu - Category: Addiction Authors: Tags: Alcohol Alcohol Rehab Information Alcoholism alcohol abuse alcohol dependence alcohol dependency alcohol detox alcohol treatment alcohol treatment center alcohol treatment facility Alcoholics Anonymous Source Type: blogs
Conclusion: The results indicate that health-related locus of control plays a role in the relationship of subjective stroke impact and depressive symptoms. It is recommended to focus on control beliefs during the recovery process of stroke survivors. For developing targeted interventions, it is necessary to further investigate these associations while incorporating various health-related control belief concepts and replicate the present findings among larger samples.
Source: Frontiers in Psychiatry - Category: Psychiatry Source Type: research
k L Abstract Purpose: To analyse trends in quality of life (QoL) development among older stroke patients within the first year after rehabilitation discharge, and to investigate the impact of including proxy interviews in research and practice.Methods: A prospective cohort study with follow-up at 3, 6, and 12 months with 411 patients and proxy respondents was conducted. The EUROHIS-QOL 8-item index was used to assess QoL. By performing descriptive analyses, QoL development over time was compared among subgroups. Linear mixed models were calculated to estimate mean changes from baseline to 12-month follow-up. ...
Source: Disability and Rehabilitation - Category: Rehabilitation Authors: Tags: Disabil Rehabil Source Type: research
CONCLUSIONS: We found no reliable evidence that SSRIs should be used routinely to promote recovery after stroke. Meta-analysis of the trials at low risk of bias indicate that SSRIs do not improve recovery from stroke. We identified potential improvements in disability only in the analyses which included trials at high risk of bias. A further meta-analysis of large ongoing trials will be required to determine the generalisability of these findings. PMID: 31769878 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
Conclusion: Cardiorespiratory training, repetitive task training, and transcranial direct current stimulation may improve ADLs in adults with stroke. Cognitive behavioral therapy, exercise, and SSRIs may reduce symptoms of poststroke depression, but use of SSRIs to prevent depression or improve motor function was not supported. Primary Funding Source: U.S. Department of Veterans Affairs, Veterans Health Administration. PMID: 31739315 [PubMed - as supplied by publisher]
Source: Annals of Internal Medicine - Category: Internal Medicine Authors: Tags: Ann Intern Med Source Type: research
Conclusion: This study opens the way for future researchers, psychologists, physiotherapist and other practitioners to do more extensive work in the domain of virtual reality with different sample, constructs and approaches.Implications for rehabilitationIt has become increasing important to introduce new state-to-art technologies in domain of rehabilitation.People are reluctant to use all the traditional modes of treatment. As these conventional ways of treatment are least motivating and interesting to indulge the patients without force and burden. It is evident in the present study that addition of virtual reality-based ...
Source: Disability and Rehabilitation. Assistive Technology. - Category: Rehabilitation Authors: Tags: Disabil Rehabil Assist Technol Source Type: research
The objective of this study was to explore the effect of social support on depression in chronic stroke patients and the relationship between demographic and disease characteristics. Total samples were randomly divided into an intervention group (n = 31) and a control group (n = 31). Sixteen social support interventions were performed over 8 weeks. Social support programs were implemented 2 times a week. Depressive symptoms were assessed at the second week, 4th week, 8th week, and 4 weeks after the end of the study using the 10-item Center for the Epidemiological Studies of Depression Short Form (CES-D10). There wa...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research
In this study, AT1-AAs were detected in the sera of patients with peripheral arterial disease (PAD) and the positive rate was 44.44% vs. 17.46% in non-PAD volunteers. In addition, analysis showed that AT1-AAs level was positively correlated with PAD. To reveal the causal relationship between AT1-AAs and vascular aging, an AT1-AAs-positive rat model was established by active immunization. The carotid pulse wave velocity was higher, and the aortic endothelium-dependent vasodilatation was attenuated significantly in the immunized rats. Morphological staining showed thickening of the aortic wall. Histological examination showe...
Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
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