Management of depression in elderly stroke patients

Management of depression in elderly stroke patients

Johan Lökk1, Ahmad Delbari1,21Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden 2Iranian Research Center on Aging, University of Social Welfare and Rehabilitation, Tehran, IranAbstract: Poststroke depression (PSD) in elderly patients has been...

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Autores principales: Johan Lökk, Ahmad Delbari
Formato: article
Lenguaje:EN
Publicado: Dove Medical Press 2010
Materias:
Neurosciences. Biological psychiatry. Neuropsychiatry
RC321-571
Neurology. Diseases of the nervous system
RC346-429
Acceso en línea:https://doaj.org/article/aceea50693d34106b68a5e41ee842e5f
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spelling oai:doaj.org-article:aceea50693d34106b68a5e41ee842e5f2021-12-02T03:17:58ZManagement of depression in elderly stroke patients1176-63281178-2021https://doaj.org/article/aceea50693d34106b68a5e41ee842e5f2010-08-01T00:00:00Zhttp://www.dovepress.com/management-of-depression-in-elderly-stroke-patients-a5126https://doaj.org/toc/1176-6328https://doaj.org/toc/1178-2021Johan Lökk1, Ahmad Delbari1,21Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden 2Iranian Research Center on Aging, University of Social Welfare and Rehabilitation, Tehran, IranAbstract: Poststroke depression (PSD) in elderly patients has been considered the most common neuropsychiatric consequence of stroke up to 6–24 months after stroke onset. When depression appears within days after stroke onset, it is likely to remit, whereas depression at 3 months is likely to be sustained for 1 year. One of the major problems posed by elderly stroke patients is how to identify and optimally manage PSD. This review provides insight to identification and management of depression in elderly stroke patients. Depression following stroke is less likely to include dysphoria and more likely characterized by vegetative signs and symptoms compared with other forms of late-life depression, and clinicians should rely more on nonsomatic symptoms rather than somatic symptoms. Evaluation and diagnosis of depression among elderly stroke patients are more complex due to vague symptoms of depression, overlapping signs and symptoms of stroke and depression, lack of properly trained health care personnel, and insufficient assessment tools for proper diagnosis. Major goals of treatment are to reduce depressive symptoms, improve mood and quality of life, and reduce the risk of medical complications including relapse. Antidepressants (ADs) are generally not indicated in mild forms because the balance of benefit and risk is not satisfactory in elderly stroke patients. Selective serotonin reuptake inhibitors are the first choice of PSD treatment in elderly patients due to their lower potential for drug interaction and side effects, which are more common with tricyclic ADs. Recently, stimulant medications have emerged as promising new therapeutic interventions for PSD and are now the subject of rigorous clinical trials. Cognitive behavioral therapy can also be useful, and electroconvulsive therapy is available for patients with severe refractory PSD.Keywords: depression, poststroke, stroke Johan LökkAhmad DelbariDove Medical PressarticleNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol 2010, Iss Issue 1, Pp 539-549 (2010)
institution DOAJ
collection DOAJ
language EN
topic Neurosciences. Biological psychiatry. Neuropsychiatry
RC321-571
Neurology. Diseases of the nervous system
RC346-429
spellingShingle Neurosciences. Biological psychiatry. Neuropsychiatry
RC321-571
Neurology. Diseases of the nervous system
RC346-429
Johan Lökk
Ahmad Delbari
Management of depression in elderly stroke patients
description Johan Lökk1, Ahmad Delbari1,21Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden 2Iranian Research Center on Aging, University of Social Welfare and Rehabilitation, Tehran, IranAbstract: Poststroke depression (PSD) in elderly patients has been considered the most common neuropsychiatric consequence of stroke up to 6–24 months after stroke onset. When depression appears within days after stroke onset, it is likely to remit, whereas depression at 3 months is likely to be sustained for 1 year. One of the major problems posed by elderly stroke patients is how to identify and optimally manage PSD. This review provides insight to identification and management of depression in elderly stroke patients. Depression following stroke is less likely to include dysphoria and more likely characterized by vegetative signs and symptoms compared with other forms of late-life depression, and clinicians should rely more on nonsomatic symptoms rather than somatic symptoms. Evaluation and diagnosis of depression among elderly stroke patients are more complex due to vague symptoms of depression, overlapping signs and symptoms of stroke and depression, lack of properly trained health care personnel, and insufficient assessment tools for proper diagnosis. Major goals of treatment are to reduce depressive symptoms, improve mood and quality of life, and reduce the risk of medical complications including relapse. Antidepressants (ADs) are generally not indicated in mild forms because the balance of benefit and risk is not satisfactory in elderly stroke patients. Selective serotonin reuptake inhibitors are the first choice of PSD treatment in elderly patients due to their lower potential for drug interaction and side effects, which are more common with tricyclic ADs. Recently, stimulant medications have emerged as promising new therapeutic interventions for PSD and are now the subject of rigorous clinical trials. Cognitive behavioral therapy can also be useful, and electroconvulsive therapy is available for patients with severe refractory PSD.Keywords: depression, poststroke, stroke
format article
author Johan Lökk
Ahmad Delbari
author_facet Johan Lökk
Ahmad Delbari
author_sort Johan Lökk
title Management of depression in elderly stroke patients
title_short Management of depression in elderly stroke patients
title_full Management of depression in elderly stroke patients
title_fullStr Management of depression in elderly stroke patients
title_full_unstemmed Management of depression in elderly stroke patients
title_sort management of depression in elderly stroke patients
publisher Dove Medical Press
publishDate 2010
url https://doaj.org/article/aceea50693d34106b68a5e41ee842e5f
work_keys_str_mv AT johanlampoumlkk managementofdepressioninelderlystrokepatients
AT ahmaddelbari managementofdepressioninelderlystrokepatients
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