Stroke and post-stroke psychiatry

Meet the patient

A 68-year-old former teacher, ten days out from a right middle cerebral artery infarct, will not engage with physiotherapy. The nurses have written "low mood, refusing care." Her son says she cried through breakfast, has not slept since admission, and told him the family "would manage better" without her.

Why the examiner cares. Despite validated screening tools and effective treatment and prevention strategies, there has been no significant reduction in the proportion of people experiencing depression after stroke.^[2] Only a minority of patients with post-stroke depression are diagnosed, and even fewer are treated in common clinical practice.^[18]

References19ShowHide

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2. [2]Hackett ML, Pickles K Part I: frequency of depression after stroke: an updated systematic review and meta-analysis of observational studies Int J Stroke, 2014.PMID 25117911
3. [3]Kutlubaev MA, Hackett ML Part II: predictors of depression after stroke and impact of depression on stroke outcome: an updated systematic review of observational studies Int J Stroke, 2014.PMID 25156411
4. [4]Ayerbe L, Ayis S, Wolfe CD, Rudd AG Natural history, predictors and outcomes of depression after stroke: systematic review and meta-analysis Br J Psychiatry, 2013.PMID 23284148
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10. [10]Mikami K, Jorge RE, Moser DJ, Arndt S, et al. Increased frequency of first-episode poststroke depression after discontinuation of escitalopram Stroke, 2011.PMID 21868736
11. [11]Allida SM, Hsieh CF, Cox KL, Patel K, et al. Pharmacological, non-invasive brain stimulation and psychological interventions, and their combination, for treating depression after stroke Cochrane Database Syst Rev, 2023.PMID 37417452
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13. [13]Chollet F, Tardy J, Albucher JF, Thalamas C, et al. Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial Lancet Neurol, 2011.PMID 21216670
14. [14]FOCUS Trial Collaboration Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial Lancet, 2019.PMID 30528472
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16. [16]EFFECTS Trial Collaboration Safety and efficacy of fluoxetine on functional recovery after acute stroke (EFFECTS): a randomised, double-blind, placebo-controlled trial Lancet Neurol, 2020.PMID 32702335
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19. [19]Prabhakaran S, Gonzalez NR, Zachrison KS, et al. 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association. Stroke, 2026.PMID 41582814