A stroke (also called a cerebrovascular accident, CVA) is an acute disturbance of the cerebral perfusion or vasculature. Approximately 85% of strokes are ischemic (blockage of a vessel) and remainder are hemorrhagic. Post-stroke, individuals are at risk for developing neuropsychiatric syndromes such as post-stroke depression and pseudobulbar affect.

For a detailed approach to diagnosing, managing, and follow up of stroke presentations, see the above main article.

Post-stroke Depression (PSD)

  • Following a stroke, the onset of depression is acute, usually occurring within 1 day or a few days of the cerebrovascular accident (CVA).[1]
  • Approximately 33% of stroke survivors develop PSD at some point, with the frequency being highest in the first year of stroke (and declines thereafter).
  • The pathophysiology of PSD involves both biological and psychosocial factors.
  • Historically, left-sided strokes were thought to place patients at greater risk for PSD, but newer studies show mixed findings (i.e. - outpatient clinics actually see depression more commonly in right-sided strokes).[2]
  • PSD can be longer lasting compared to non-stroke depression due its multifactorial nature, and is more difficult to treat with antidepressants.

Don't Try to Use Antidepressants as a Prophylaxis to Prevent PSD!

The prophylactic use of SSRIs in post-stroke neurological recovery is not beneficial. Two recent randomized control trials demonstrated no difference from placebo, and in fact, an increased risk of fractures, falls, and seizures.[5][6][7] However, SSRIs can still be used to treat post-stroke depression.

Pseudobulbar affect (PBA) (also known as emotional lability, reflex crying or laughing, emotional incontinence, and involuntary emotional expression disorder) is a neuropsychiatric syndrome common in neurological disorders including stroke, amyotrophic lateral sclerosis (ALS), Parkinson’s, traumatic brain injury, multiple sclerosis, dementia, Wilson’s disease, and brain tumors. PBA is not a mood disorder, but rather an abnormal display of affect that does not match an individual’s true (internal) feelings.

Stroke Guidelines

Guideline Location Year PDF Website
Heart and Stroke Foundation of Canada Canada 2019 PDF Link
National Health Service (NHS) UK 2012 - Link
American Heart Association (AHA) and American Stroke Association (ASA) USA 2016 Link -