From the Research
More than 50% of patients with major stroke require psychological follow-up in the chronic phase of stroke, as evidenced by the high prevalence of post-stroke depression, anxiety, and adjustment disorders. This significant proportion reflects the common occurrence of psychological distress that often develops weeks to months after the initial event, as reported in a study published in 2011 1. Psychological support typically involves regular sessions with a psychologist or psychiatrist, cognitive behavioral therapy, and sometimes medication such as selective serotonin reuptake inhibitors (SSRIs) like sertraline (50-200 mg daily) or escitalopram (10-20 mg daily) for 6-12 months or longer depending on symptom resolution.
The importance of early screening for psychological symptoms cannot be overstated, and it should begin before hospital discharge and continue at follow-up appointments at 1,3,6, and 12 months post-stroke. The high prevalence of psychological sequelae stems from both the neurobiological changes in brain chemistry following stroke and the psychological adjustment to disability, loss of independence, and changed life circumstances. Addressing these issues is crucial as untreated psychological conditions can significantly impair rehabilitation outcomes, functional recovery, and overall quality of life.
Some studies have investigated the effectiveness of interventions for psychological issues faced by individuals post-stroke, including repetitive transcranial magnetic stimulation, pharmacotherapy, and exercise, which have shown promise in improving mood and adjustment in the chronic stage of stroke 2. Additionally, mind-body interventions such as yoga or tai chi may also be beneficial in reducing psychological stressors and improving quality of life in stroke survivors, although more research is needed to confirm these findings 3.
It is also important to note that SSRIs may be effective in reducing the risk of future depression in stroke patients, but they do not appear to make a significant difference in disability or independence after stroke compared to placebo or usual care, and may increase the risk of bone fractures and seizures 4.
Recent studies have highlighted the importance of psychological resilience in stroke patients, which is influenced by a variety of factors including self-efficacy, hope, confrontation coping, avoidance coping, functional independence, quality of life, and social support 5.
Key points to consider in the management of psychological sequelae after stroke include:
- Early screening for psychological symptoms
- Regular follow-up appointments to monitor psychological distress
- Psychological support, including cognitive behavioral therapy and medication if necessary
- Promotion of psychological resilience through targeted interventions
- Consideration of the potential benefits and risks of SSRIs in stroke patients.