Post-stroke psychoemotional disorders: modern medical therapy

July 4, 2018
Specialities :

A review of the literature on some of the most common psychoemotional disorders noted after a stroke, a phenomenology of mood and emotional disorders are presented. The prevalence of psychoemotional disorders, their negative impact on the recovery of neurological disorders and cognitive functions are given. The necessity of timely diagnosis and correction of emotional disturbances in patients who underwent acute cerebrovascular accident and the effectiveness of the integrated approach in treatment were substantiated. The general pathogenetic links in the development of post-stroke psychoemotional disorders — depression, anxiety and their connection with the process of rehabilitation and social rehabilitation of patients were described, as well as the possibility of pharmacotherapy with selective serotonin reuptake inhibitors, in particular escitalopram.

Published: 27.06.2018


  • Veyn A.M., Voznesenskaya T.G., Golubev V.L. i dr. (2007) Depressiya v nevrologicheskoy praktike (klinika, diagnostika, lechenie). MIA, Moskva, 208 s.
  • Vorobeva O.V. (2011) Postinsultnaya depressiya: neobhodimost naznacheniya antidepressantov. Effektivnaya farmakoterapiya. Nevrologiya i psihiatriya, 5: 34–37.
  • Kadyikov A.S., Shahparonova N.V., Grishina D.A. (2009) Postinsultnaya depressiya. Vzglyad nevrologa. Atmosfera. Nervnyie bolezni, 4: 41–42.
  • Kaplan G.I., Sedok B. Dzh. (1994) Klinicheskaya psihiatriya. Meditsina, Moskva, 672 s.
  • Mischenko T.S. (2011) Glavnyiy spetsialist Ministerstva zdravoohraneniya Ukrainyi o profilaktike i lechenii mozgovogo insulta. med. chasopis, 6(86): 39–41.
  • Skvortsova V.I., Kontsevoy V.A., Petrova E.A. i dr. (2009) Depressii i paradepressivnyie rasstroystva pri tserebralnom insulte: voprosyi klinicheskoy otsenki, diagnostiki i korrektsii. Zhurn. nevrol. psihiatr., 9: 4–11.
  • Baldwin D.S., Loft H., Dragheim M. (2012) A randomised, double-blind, placebo controlled, duloxetine-referenced, fixed-dose study of three dosages of Lu AA21004 in acute treatment of major depressive disorder (MDD). Eur. Neuropsychopharmacol., 22(7): 482–489.
  • Campbell Burton C.A., Holmes J., Murray J. et al. (2011) Interventions for treating anxiety after stroke. Cochrane Database Syst. Rev., 12: CD008860.
  • Campbell Burton C.A., Murray J., Holmes J. et al. (2013) Frequency of anxiety after stroke: a systematic review and meta-analysis of observational studies. Int. J. Stroke, 8: 545–559.
  • Cattaneo A., Bocchio-Chiavetto L., Zanardini R. et al. (2010) Reduced peripheral brain-derived neurotrophic factor mRNA levels are normalized by antidepressant treatment. Int. J. Neuropsychopharmacol., 13(1): 103–108.
  • Choi-Kwon S., Han S.W., Kwon S.U. et al. (2006) Fluoxetine treatment in poststroke depression, emotional incontinence, and anger proneness: a double-blind, placebo-controlled study. Stroke, 37: 156–161.
  • Cipriani A., Santilli C., Furukawa T.A. et al. (2009) Escitalopram versus other antidepressive agents for depression. Cochrane Database Syst. Rev., 2: CD006532.
  • Cramer S.C. (2008) Repairing the human brain after stroke, II: restorative therapies. Ann. Neuol., 63(5): 549–560.
  • European Stroke Organisation (ESO) Executive Committee (2008) ESO Writing Committee. Guidelines for management ofischaemic stroke and transient ischaemic attack. Cerebrovasc. Dis., 25: 457–507.
  • Ferro J.M., Caeiro L., Santos C. (2009) Poststroke emotional and behavior impairment: a narrative review. Cerebrovasc Dis., 27(Suppl. 1): 197–203.
  • Fleminger S., Greenwood R.J., Oliver D.L. (2006) Pharmacological management for agitation and aggression in people with acquired brain injury. Cochrane Database Syst. Rev., CD003299.
  • Gaete J.M., Bogousslavsky J. (2008) Post-stroke depression. Exp. Rev. Neurother., 8: 75–92.
  • Gaspar P., Cases O., Maroteaux L. (2003) The developmental role of serotonin: news from mouse molecular genetics. Nat. Rev. Neuroscl., 4(12): 1002–1012.
  • Gillen R., Tennen H., McKee T.E. et al. (2011) Depressive symptoms and history of depression predict rehabilitation efficiency in stroke patients. Arch. Phys.Med. Rehabil., 82: 1645–1649.
  • Glenn M.B., Wroblewski B., Parziale J. et al. (1989) Lithium carbonate for aggressive behavior or affective instability in ten brain-injured patients. Am. J. Phys. Med. Rehabil., 68: 221–226.
  • Greenop K.R., Almeida O.P., Hankey G.J. et al. (2009) Premorbid personality traits are associated with post-stroke behavioral and psychological symptoms: a three-month follow-up study in Perth, western Australia. Int. Psychogeriatr., 21: 1063–1071.
  • Hackett M.L., Anderson C.S., House A. et al. (2008) Interventions for preventing depression after stroke. Cochrane Database Syst. Rev., CD003689.
  • Hackett M.L., Pickles K. (2014) Part I: Frequency of depression after stroke: an updated systematic review and meta-analysis of observational studies. Int. J.Stroke, 9: 1017–1025.
  • Jorge R.E., Acion L., Moser D. et al. (2010) Escitalopram and enhancement of cognitive recovery following stroke. Arch. Gen. Psychiatry, 67(2): 187–196.
  • Khasanova D.R., Zhitkova Yu.V. (2013) Use of escitalopram to prevent depression and cognitive impairments in the acute phase of stroke. Neurology, neuropsychiatry, psychosomatics, (2S): 22–27.
  • Kim J.S. (2016) Post-stroke Mood and Emotional Disturbances: Pharmacological Therapy Based on Mechanisms. J. Stroke,18(3): 244–255.
  • Kim J.S., Choi S., Kwon S.U. (2000) Poststroke depression and emotional incontinence: Correlation with lesion location. Neurology, 54: 1805–1810.
  • Kim J.S., Choi S., Kwon S.U., Seo Y.S. (2002) Inability to control anger or aggression after stroke. Neurology, 58: 1106–1108.
  • Kim J.S., Lee E.J., Chang D.I. et al. (2017) Efficacy of early administration of escitalopram on depressive and emotional symptoms and neurological dysfunction after stroke: a multicentre, double-blind, randomised, placebo-controlled study. Lancet Psychiatry, 4(1): 33–41 (doi: 10.1016/S2215-0366(16)30417-5).
  • Labi M.L.C., Phillips T.F., Gresham G.E. (1980) Psychosocial disability in physically restored long-term stroke survivors. Arch. Phys. Med. Rehabil., 61: 561–565.
  • Liman T.G., Heuschmann P.U., Endres M. et al. (2012) Impact of low mini-mental status on health outcome up to 5 years after stroke: the erlangen stroke project. J. Neurol., 259: 1125–1130.
  • Martinowich K., Lu B. (2007) Interaction between BDNF and serotonin: role in mood disorders.Neuropsychopharmacology, 33(1): 73–83.
  • Miller E.L., Murray L., Richards L. et al. (2010) Comprehensive overview of nursing and interdisciplinary rehabilitation care of the stroke patient: a scientific statement from the American Heart Association. Stroke, 41: 2402–2448.
  • Morrison V., Pollard B., Johnston M. et al. (2005) Anxiety and depression 3 years following stroke: demographic, clinical, and psychological predictors. J. Psychosom. Res., 59: 209–213.
  • National Institute for Health and Care Excellence (2011) Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults: management in primary, secondary and community care.
  • Navarro V., Gasto C., Lomena F. et al. (2002) Normalization of frontal cerebral perfusion in remitted elderly major depression: a 12-month follow-up SPECT study. Neuroimage, 16(3): 781–787.
  • Pandya R.S., Mao L., Zhou H. et al. (2011) Central nervous system agents for ischemic stroke: neuroprotection mechanisms. Cent. Nerv. Syst. Agents Med. Chem., 11(2): 81–97.
  • Pollock B.G., Mulsant B.H., Rosen J. et al. (2007) A double-blind comparison of citalopram and risperidone for the treatment of behavioral and psychotic symptoms associated with dementia. Am. J. Geriatr. Psychiatr., 15(11): 942–952.
  • Quinn T.J., Paolucci S., Sunnerhagen K.S. et al. (2009) Evidence-based stroke rehabilitation: an expanded guidance document from the european stroke organisation (ESO) guidelines for management of ischaemic stroke and transient ischaemic attack 2008. J. Rehabil. Med., 41: 99–111.
  • Radley J.J., Jacobs B.L. (2002) 5-HT1A receptor antagonist administration decreases cell proliferation in the dentate gyrus. Brain Res., 955(1–2): 264–267.
  • Robinson R.G., Jorge R.E. (2016) Post-stroke depression: a review. Am. J. Psychiatr., 173: 221–231.
  • Robinson R.G., Jorge R.E., Moser D.J. et al. (2008) Escitalopram and problem-solving therapy for prevention of poststroke depression: a randomized controlled trial. JAMA, 299(20): 2391–2400.
  • Robinson R.G., Kubos K.L., Srarr L.B. et al. (1984) Mood changes in stroke patients: relation tolesion location. Brain, 107: 81–93.
  • Starkstein S.E., Cohen B.S., Fedoroff P. et al.(1990) Relationship between anxiety disorders and depressive disorders in patients with cerebrovascular injury. Arch. Gen. Psychiatr., 47: 246–251.
  • Townend B.S., Whyte S., Desborough T. et al. (2007) Longitudinal prevalence and determinants of early mood disorder post-stroke. J. Clin. Neurosci., 14: 429–434.
  • Tsai C.S., Wu C.L., Chou S.Y. et al. (2011) Prevention of poststroke depression with milnacipran in patients with acute ischemic stroke: a double-blind randomized placebo-controlled trial. Int. Clin. Psychopharmacol., 26: 263–267.
  • Verdelho A., Henon H., Lebert F. et al. (2004) Depressive symptoms after stroke and relationship with dementia. A three-year follow-up study. Neurology, 62: 905–911.