Epidemiological analysis, risk factors and therapeutic plan for post-stroke depression

Background: the stroke is defined by the OMS as the rapid development of neurological symptoms and/or focal signs that last for more than 24 hours, resulting from the sudden change in blood flow to the region. Major depressive disorder is one of the main complications that exist after a stroke. Objectives to correlate the occurrence of depression and stroke, to analyze the risk factors and the best therapeutic approach for the condition. Methods: a literature review was carried out from the Scielo and PubMed database, using as descriptors “Stroke”, “Depression” and “Post-stroke depression”, where 13 articles between 2003 and 2018 were selected. Results: the major depressive disorder is the most common psychiatric complication after strokes. A meta-analysis identified a cumulative incidence of depression from 29% to 52% in the first five years after stroke, although several studies have shown that post-stroke depression is diagnosed in only 10% of cases. When not diagnosed or treated, it is associated with a reduction in the patient’s active participation in the rehabilitation process, a decrease in quality of life and an increase in mortality. Risk factors include previous functional and cognitive impairment, history of depressive disorder, sex, age, previous stroke, hypercortisolemia, poor social support network, neuroanatomical characteristics of the stroke and high serum levels of IL-6. The pharmacological management can be carried out prophylactically or therapeutically, with selective serotonin reuptake inhibitors being the most indicated and tricyclic antidepressants as an alternative. Conclusion: the frequency of depressive disorder after stroke is relatively high and characterized as a predictor of poor prognosis. The importance of attention to the multifactorial context in which depression arises and the early treatment of psychiatric comorbidities in post-stroke individuals should be reinforced, since this strategy may reflect on better quality of life and reduction in morbidity and mortality rates that occur after the condition.