Section - Quick Takes

05. Poststroke Depression: Recognizing and Managing Mood Symptoms

Published on May 1, 2024 Certification expiration date: May 1, 2027

Scott R. Beach, M.D.

Associate Professor of Psychiatry - Harvard Medical School - Massachusetts General Hospital

Key Points

Up to one-third of stroke patients experience depressive symptoms, making depression the most common neuropsychiatric sequela of stroke.
Poststroke depression overlaps considerably with major depressive disorder, but anhedonia may be less common or severe.
SSRIs and mirtazapine are considered effective first-line treatments for poststroke depression.

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In addition to developing deficits in motor functioning and speech, it is not unusual for patients to develop affective changes following a stroke. Depression is the most common and most burdensome neuropsychiatric sequela in stroke, with up to one-third of patients experiencing depressive symptoms after the stroke. The classic teaching holds that left frontal lobe lesions traditionally cause depressive symptoms, whereas right frontal lobe lesions may cause maniform symptoms, including mood lability, impulsivity, and disinhibition. More recent evidence suggests that things are probably more complicated than this. Still, psychiatrists nonetheless should be aware of the potential for strokes to significantly affect the mental health of patients and lead to worsening mood symptoms.

I am Scott Beach, and this is Quick Takes for the Psychopharmacology Institute.

A recent review in Neuropsychology Review sets out to compare the symptomatology in poststroke depression with that of major depressive disorder in an attempt to

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Learning Objectives:

After completing this activity, the learner will be able to:

Analyze the potential risks and benefits of antipsychotic dose reduction for patients with chronic, relapsing schizophrenia.
Analyze the current limitations and uncertainties surrounding psilocybin treatment in clinical practice.
3. Evaluate the risk–benefit profile of recommending famotidine for COVID-19 brain fog based on available evidence.
Evaluate the potential benefits of long-acting injectable antipsychotics in the treatment of bipolar disorder based on real-world evidence.
Compare and contrast the symptomatology of poststroke depression with that of major depressive disorder.

Original Release Date: May 1, 2024

Expiration Date: May 1, 2027

Experts: Scott Beach, M.D., David Gorelick, M.D., Oliver Freudenreich, M.D., Paul Zarkowski, M.D.

Medical Editor: Lorena Rodriguez, M.D.

Relevant Financial Disclosures:

Oliver Freudenreich declares the following interests:

- Alkermes: Research grant, consultant honoraria

- Janssen: Research grant, consultant honoraria

- Otsuka: Research grant

- Karuna: Research grant, consultant honoraria

- Neurocrine: Consultant honoraria

- Vida: Consultant honoraria

- American Psychiatric Association: Consultant honoraria

- Medscape: Honoraria

- Elsevier: Honoraria

- Wolters-Kluwer: Royalties

- UpToDate: Royalties, honoraria

David Gorelick declares the following interests:

- Wolters-Kluwer: Honoraria
- Springer Nature & Colorado State University, Pueblo: Honoraria

All of the relevant financial relationships listed above have been mitigated by Medical Academy and the Psychopharmacology Institute.

None of the other faculty, planners, and reviewers for this educational activity have relevant financial relationships to disclose during the last 24 months with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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