Depressive disorders following stroke: Diagnostic and pharmacotherapeutic considerations

Rehabilitation following stroke is often complicated by the presence of clinical depressive disorders, with a prevalence as high as 40%. Such disorders, which may be more common in patients with left prefrontal lesions, may emerge gradually during the months after stroke and may not be detected unless patients and families are specifically questioned. Pharmacotherapy for depression is effective and well tolerated, leading to dramatically enhanced quality of life, improved function and return to work, and prevention of serious and life threatening sequelae of depression including suicide and medical morbidities. Current antidepressant medications, such as the selective serotonin reuptake inhibitors (SSRIs), can be readily managed by nonpsychiatrist physicians and have few side effects that compromise rehabilitation. Therapists can play an important educational and supportive role in enhancing medication compliance and clinical recovery, especially during the initial weeks of a depressive episode prior to the onset of the antidepressant response.