Determinants and consequences of post-stroke depression

Post-stroke depression (PSD) is a very frequent and important consequence of stroke, but, in spite of the high number of papers aiming to clarify various aspects of this disorder, controversies about its incidence, its (biological or psychological) determinants, its consequences and its treatment still persist. In the present survey we have taken separately into account each of these issues, starting from a critical discussion of the main factors which can affect the estimates of the incidence of PSD. We have then surveyed and updated the debate between proponents of a neuroanatomical and a psychological interpretation of PSD. Our conclusions have been that the most recent evidence does not support Robinson's influential neuroanatomical model, assuming that a left frontal stroke could provoke a major PSD, indistinguishable from the functional forms of major depression. In the section devoted to the consequences of PSD, we have particularly taken into account the problem of the deleterious influence that PSD could have on functional recovery. The available evidence does not allow us to conclude if an improvement of PSD also leads to an improvement of the patient's functional status. As for the therapy of PSD, a pharmacological treatment with selective serotonin reuptake inhibitors has proven effective and safe, whereas psychological methods of treatment of patients and their families have not yet given conclusive results.