An updated review on prediction and preventive treatment of post-stroke depression

ABSTRACT

Introduction

Post-stroke depression (PSD), one of the most common complications following stroke, affects approximately one-third of stroke patients and is significantly associated with increased disability and mortality as well as decreased quality of life, which makes it an important public health concern. Treatment of PSD significantly ameliorates depressive symptoms and improves the prognosis of stroke.

Areas covered

The authors discuss the critical aspects of the clinical application of prediction and preventive treatment of PSD. Then, the authors update the biological factors associated with the onset of PSD. Furthermore, they summarize the recent progress in pharmacological preventive treatment in clinical trials and propose potential treatment targets. The authors also discuss the current roadblocks in the preventive treatment of PSD. Finally, the authors put postulate potential directions for future studies so as to discover accurate predictors and provide individualized preventive treatment.

Expert opinion

Sorting out high-risk PSD patients using reliable predictors will greatly assist PSD management. Indeed, some predictors not only predict the incidence of PSD but also predict prognosis, which indicates that they might also aid the development of an individualized treatment scheme. Preventive application of antidepressants may also be considered.

KEYWORDS:

• Post-stroke depression
• pediction
• biological factors
• preventive treatment
• antidepressants

Article highlights

• A wide variety of biological factors have been developed to assess the risk of PSD such as monoamine-related, inflammation-related, neurotrophic-related, HPA axis-related, mitochondrial, and oxidative stress-related biological factors.

• Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) now act as antidepressants for PSD prevention.

• Studies at different times have different conclusions on whether lesion location is correlated with PSD.

• Early use of antidepressants in non-depressed stroke patients has shown promising results in preventing PSD in clinical trials.

• Anti-inflammatory drugs, mitochondrial and antioxidative stress agents, vitamin D, and blood glutamate scavenging are possible and potential preventive treatment candidates for PSD.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The authors are funded by the National Natural Science Foundation of China under grants 81820108010 (to B Hu) and 82171306 (to H Jin).