[Depression, anxiety and other emotional symptoms after cerebral stroke]

Abstract

Background: Emotional symptoms are probably among the most ignored impairments in stroke patients. Of these, depression is best described, and appears in 20-40% of the stroke patients. Other emotional symptoms are anxiety (20-30%), emotional instability (10-25%), crisis reaction (20%) and reduced initiative and fatigue (50-70%). Depression and anxiety are, according to some publications, related to organic lesions in the anterior parts of the left hemisphere, although this relationship is under discussion. In addition, marital status and neurological impairments correlate with emotional symptoms in stroke.

Material and methods: The manuscript is based on a Medline search (1980-2006) and on own clinical experience and research.

Results and interpretation: Several diagnostic instruments are in use to identify emotional symptoms in patients who suffer from stroke. Of these, the Montgomery-Asberg-Depression-Rating-Scale, the Geriatric Depression Scale and the Hospital Anxiety and Depression Scale are the most frequently used to diagnose post-stroke anxiety and depression in Norway. Aphasia and other cognitive impairments do however make these instruments difficult to use. At present, pharmacological treatment consists of selective serotonine reuptake inhibitors and serotonine noradrenaline reuptake inhibitors. Tricyclic antidepressive therapy is also effective, but often unsuitable due to side effects. Post-stroke emotional symptoms may affect the patients' neurological outcome, and should be emphasized more in the stroke unit. Documentation is insufficient regarding the effects of medical intervention, and more knowledge is needed.