Post Stroke Depression

Question 1

Post stroke depression

Answer 1

Post stroke depression is common (30-40%). Lesions in the vicinity of the left hemisphere basal ganglia tend to play a crucial role in the development of major depression after the acute stage of stroke (Herrmann 1995).

Treatment needs to take into consideration any medical co-morbidity and other treatment (e.g. warfarin).

The following drugs are recommended for post stroke depression:-

SSRIs
Mirtazapine
Nortriptyline

Fluoxetine, citalopram, and nortriptyline are the most studied and seem to be effective and safe.

If patients are on warfarin then citalopram or escitalopram is recommended.

Prophylaxis

In view of the high incidence of depression following stroke there has been considerable research into antidepressant prophylaxis.

The following have been shown to be effective at preventing post stroke depression:-

Nortriptyline
Fluoxetine
Escitalopram
Sertraline
Mirtazapine

Mianserin appears to be ineffective.

Question 2

Pt on warfarin

Answer 2

In post stroke depression, if patients are on warfarin then citalopram is recommended.
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