From the Research
Approximately 33.9% of patients with major stroke require psychiatric follow-up in the chronic phase of stroke. This need arises because post-stroke depression, anxiety, and other psychiatric conditions are common sequelae of major stroke events, as highlighted in a recent study 1. Patients should be screened for depression and anxiety at regular intervals during stroke recovery, particularly at the 3-month, 6-month, and 1-year marks. Psychiatric follow-up typically involves assessment by a psychiatrist or neuropsychiatrist who can prescribe appropriate medications such as SSRIs (like sertraline 50-100mg daily or escitalopram 10-20mg daily) for depression or anxiety. These medications often require 4-6 weeks for full effect and may need to be continued for 6-12 months or longer. Non-pharmacological interventions including cognitive behavioral therapy and support groups are also beneficial. The need for psychiatric care stems from the neurobiological changes that occur after stroke, including disruption of neural circuits involved in mood regulation, as well as the psychological impact of disability and life changes. Early identification and treatment of psychiatric conditions can significantly improve functional outcomes, quality of life, and participation in rehabilitation efforts.
Some key points to consider in the management of post-stroke psychiatric conditions include:
- In-hospital symptoms of depression and anxiety are strong risk factors for post-stroke depression 90 days after ischemic stroke 1
- SSRIs may be effective in reducing post-stroke disability and depression, but the evidence is not consistent across all studies 2, 3
- Cognitive behavioral therapy and support groups can be beneficial in addition to pharmacological interventions
- The frequency of post-stroke depression is around 33.9%, highlighting the need for regular screening and follow-up 1
It is essential to prioritize the management of post-stroke psychiatric conditions to improve outcomes and quality of life for patients with major stroke. Regular screening and follow-up are crucial to identify patients who require psychiatric intervention, and a multidisciplinary approach involving psychiatrists, neuropsychiatrists, and other healthcare professionals is necessary to provide comprehensive care.