Depression and Psychological Distress as Risk Factors for Stroke and Worse Stroke Recovery: Clinical Implications and Therapeutic Options

Stroke and depression have a strong bidirectional association: on the one hand, depression and psychosocial distress are well known risk factors for stroke; on the other hand, stroke is known to be a strong risk factor for depression. In the first 2 years after a stroke approximately one-third of patients suffer from a post-stroke depression (PSD). PSD aggravates the burden of physical, psychological, and social disability after stroke, and hinders patient participation in rehabilitation. PSD is associated with a poorer outcome and increased mortality. For the treatment of PSD, selective serotonin reuptake inhibitors (SSRIs) were recommended. Interestingly, SSRIs also have positive effects on motor recovery in stroke patients even without depression, but may increase vascular risk.