Stroke

Post-stroke, individuals are at risk for post-stroke depression and other neuropsychiatric changes, which can occur during any stage of recovery.

Post-stroke Depression

The prevalence of post-stroke depression (PSD) is anywhere between 35 to 60%. Historically, left-sided strokes were thought to place patients at greater risk for PSD, but newer studies show mixed findings (i.e. - outpatient clinics see PSD more commonly in right-sided strokes). PSD can be longer lasting due its multifactorial nature, and is more difficult to treat with antidepressants.

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.[1][2][3] 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 occurs due to disconnect between the frontal lobe (which regulates and emotions) and the cerebellum and brain stem (where reflexes are mediated).