Post‐stroke depression: the case for augmented, individually tailored cognitive behavioural therapy

In this review, we begin by considering why post‐stroke depression (PSD) is so prevalent. We then examine the current evidence base to support cognitive behavioural therapy (CBT) as a treatment approach for the condition. While there is limited evidence currently, we demonstrate that much remains to be established with regard to PSD and the efficacy of CBT. We argue there is every reason to believe CBT should be an effective treatment, but that clinicians must augment and individually tailor this approach to ensure effectiveness. We set out our rationale for a novel augmented, individually tailored CBT protocol, and describe five key components that we believe once incorporated, and tested using randomized controlled methods, should enhance treatment outcome of PSD. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: • Depression is a common consequence of stroke. • Despite a lack of clear evidence, there is reason to believe cognitive behavioural therapy (CBT) for post‐stroke depression should be effective, if it is adapted and tailored to the specific needs of stroke survivors. • Augmented and individually tailored therapy using motivational interviewing techniques, grief resolution, selection optimization compensation, cognitive deficits adaptations and executive skills training is recommended. • It is important to individualize augmented CBT, based on principles of case formulation.