Diagnosis and clinical management of post-stroke depression

Major or minor depression occurs in almost half of relatively unselected acute stroke patients and continues for more than six months. The most important determinant of its type and severity is lesion location. Left frontal lesions produce major depressive disorder in more than half of the patients, and the closer the anterior border of the lesion is to the frontal pole, the more severe the depression. In contrast, patients with right frontal lesions show an inappropriately cheerful but apathetic state. Time elapsed since stroke also is an important variable for prevalence of depression, and the high-risk period for post-stroke depression lasts for two years. Some mood disorders in stroke patients may result from injury to the norepinephrine-containing neurons as they arborize throughout the cerebral cortex, and this may explain the association with anterior hemisphere injury.