Neurology, Neuropsychiatry, Psychosomatics

Advanced search

Post-stroke depression and the abilities of antidepressants to enhance the effectiveness of neurorehabilitation

Full Text:


Stroke is the leading cause of disability in adults. Depression after a stroke is detected in one third of patients, complicating physical rehabilitation, worsening functional outcome, increasing mortality rates. The question of the use of antidepressants in the treatment of post-stroke depression is currently not completely resolved, there is no consensus on the most optimal drug. The drugs of choice are selective serotonin reuptake inhibitors, the use of tricyclic antidepressants is possible. A number of clinical studies indicate the effectiveness of selective serotonin reuptake inhibitors in the treatment of post-stroke depression, including through mechanisms including increased neuroplasticity and stimulation of neurogenesis, while others disprove their effectiveness. The article presents a clinical case of the use of vortiroxetin in the patient’s neurorehabilitation in the early recovery period of a stroke, its safety and positive effect are shown.

About the Authors

S. V. Kotov
M.F. Vladimirsky Moscow Regional Research Clinical Institute
Russian Federation

Sergei Viktorovich Kotov

61/2, Shchepkin St., Build. 1, Moscow 129110

E. V. Isakova
M.F. Vladimirsky Moscow Regional Research Clinical Institute
Russian Federation

61/2, Shchepkin St., Build. 1, Moscow 129110

Yu. V. Egorova
M.F. Vladimirsky Moscow Regional Research Clinical Institute
Russian Federation

61/2, Shchepkin St., Build. 1, Moscow 129110


1. Feigin VL, Forouzanfar MH, Krishnamurthi R, et al. Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010 [published correction appears in Lancet. 2014 Jan 18;383(9913):218]. Lancet. 2014 Jan 18;383(9913):245-54. doi: 10.1016/s0140-6736(13)61953-4

2. Kadykov AS, Chernikova LA, Shakhparonova NV. Reabilitatsiya nevrologicheskikh bol'nykh [Rehabilitation of neurological patients]. Moscow: MEDpress-inform; 2009. 555 p. (In Russ.).

3. Filatova EG. Post-stroke depression. Meditsinskiy sovet. 2017;(5):47-51 (In Russ.).

4. Robinson RG, Jorge RE. Post-Stroke Depression: A Review. Am J Psychiatry. 2016 Mar 1;173(3):221-31. doi: 10.1176/appi.ajp.2015.15030363. Epub 2015 Dec 18.

5. 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 Jan;202(1):14-21. doi: 10.1192/bjp.bp.111.107664

6. 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 Dec;9(8):1017-25. doi: 10.1111/ijs.12357. Epub 2014 Aug 12.

7. Bogolepova AN. The role of neurotrophic factors in the development of post-stroke depression. Consilium Medicum. 2019;21(2):18-23 (In Russ.).

8. Kronenberg G, Katchanov J, Endres M. Poststroke-Depression: Klinik, Epidemiologie, Therapie, pathophysiologische Konzepte [Poststroke depression: clinical aspects, epidemiology, therapy, and pathophysiology]. Nervenarzt. 2006;77(10):1176-85.

9. Towfighi A, Ovbiagele B, El Husseini N, et al. Poststroke Depression: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2017;48(2):e30-e43. doi: 10.1161/STR.0000000000000113

10. Hackett ML, Anderson CS, House A, Halteh C. Interventions for preventing depression after stroke. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD003689. doi: 10.1002/14651858.CD003689.pub3.

11. Paolucci S, Iosa M, Coiro P, et al. Poststroke Depression Increases Disability More Than 15% in Ischemic Stroke Survivors: A Case-Control Study. Front Neurol. 2019 Aug 27;10:926. doi: 10.3389/fneur.2019.00926. eCollection 2019.

12. Yu S, Arima H, Bertmar C, et al. Depression but not anxiety predicts recurrent cerebrovascular events. Acta Neurol Scand. 2016;134(1):29-34.

13. Hong JP, Park S, Ahn SH, Kim JS. Factors associated with post-stroke suicidal death. J Psychiatr Res. 2018 Jan;96:135-7. doi: 10.1016/j.jpsychires.2017.10.005. Epub 2017 Oct 7.

14. Chollet F, Rigal J, Marque P, et al. Serotonin Selective Reuptake Inhibitors (SSRIs) and Stroke. Curr Neurol Neurosci Rep. 2018 Oct 23;18(12):100. doi: 10.1007/s11910-018-0904-9

15. Kim JM, Stewart R, Kang HJ, et al. A longitudinal study of BDNF promoter methylation and genotype with poststroke depression. J Affect Disord. 2013 Jul;149(1- 3):93-9. doi: 10.1016/j.jad.2013.01.008. Epub 2013 Feb 8.

16. Asadollahi M, Ramezani M, Khanmoradi Z, Karimialavijeh E. The efficacy comparison of citalopram, fluoxetine, and placebo on motor recovery after ischemic stroke: a double-blind placebo-controlled randomized controlled trial. Clin Rehabil. 2018 Aug;32(8):1069-75. doi: 10.1177/0269215518777791. Epub 2018 May 21.

17. Villa RF, Ferrari F, Moretti A. Post-stroke depression: Mechanisms and pharmacological treatment. Pharmacol Ther. 2018 Apr;184:131- 44. doi: 10.1016/j.pharmthera.2017.11.005. Epub 2017 Nov 9.

18. Levada OA, Troyan AS. Poststroke Depression Biomarkers: A Narrative Review. Front Neurol. 2018 Jul 16;9:577. doi: 10.3389/fneur.2018.00577. eCollection 2018.

19. Hackam DG, Mrkobrada M. Selective serotonin reuptake inhibitors and brain hemorrhage: a meta-analysis. Neurology. 2012 Oct 30;79(18):1862-5. doi: 10.1212/WNL.0b013e318271f848. Epub 2012 Oct 17.

20. Coupland C, Dhiman P, Morriss R, et al. Antidepressant use and risk of adverse outcomes in older people: population based cohort study. BMJ. 2011 Aug 2;343:d4551. doi: 10.1136/bmj.d4551

21. D'Anci KE, Uhl S, Oristaglio J, et al. Treatments for Poststroke Motor Deficits and Mood Disorders: A Systematic Review for the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Guidelines for Stroke Rehabilitation. Ann Intern Med. 2019 Dec 17;171(12):906-15. doi: 10.7326/M19-2414. Epub 2019 Nov 19.

22. Kotov SV, Isakova EV, Sheregeshev VI. Possibility of correction of emotional and behavioral disorders in patients with stroke during rehabilitation treatment. Zhurnal nevrologii i psikhiatrii im. C.C. Korsakova. 2019;119(4):26- 31 (In Russ.).

23. Kotov SV, Isakova EV, Zaytseva EV, Chervinskaya AD. Sposob reabilitatsii patsiyentov s postinsul'tnymi narusheniyami. Patent na izobreteniye RU 2688723 C1, 22.05.2019. Zayavka _ 2018119363 ot 25.05.2018 [Method for the rehabilitation of patients with poststroke disorders. Invention patent RU 2688723 C1, 05/22/2019. Application No. 2018119363 dated 05.25.2018 (In Russ.)].

24. Kotov SV, Isakova EV, Slyun'kova EV. Usage of brain – computer interface+exoskeleton technology as a part of complex multimodal stimulation in the rehabilitation of patients with stroke. Zhurnal nevrologii i psikhiatrii im. C.C. Korsakova. 2019;119(12-2):37-42 (In Russ.).

25. Zaytseva EV, Isakova EV. The effectiveness of multimodal stimulation in the rehabilitation of a patient after ischemic stroke. Klinicheskaya gerontologiya. 2019;25(3-4):64-9 (In Russ.).

26. Chollet F, Tardy J, Albucher JF, et al. Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial [published correction appears in Lancet Neurol. 2011 Mar;10(3):205]. Lancet Neurol. 2011;10(2):123-30. doi: 10.1016/S1474-4422(10)70314-8

27. Mead GE, Hsieh CF, Lee R, et al. Selective serotonin reuptake inhibitors (SSRIs) for stroke recovery. Cochrane Database Syst Rev. 2012 Nov 14;11(11):CD009286. doi: 10.1002/14651858.CD009286.pub2

28. FOCUS Trial Collaboration. Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial. Lancet. 2019;393(10168):265-74. doi: 10.1016/S0140-6736(18)32823-X

29. Karaiskos D, Tzavellas E, Spengos K, et al. Duloxetine versus citalopram and sertraline in the treatment of poststroke depression, anxiety, and fatigue. J Neuropsychiatry Clin Neurosci. Summer. 2012;24(3):349-53. doi: 10.1176/appi.neuropsych.11110325

30. Sun Y, Liang Y, Jiao Y, et al. Comparative efficacy and acceptability o f antidepressant treatment in poststroke depression: a multiple-treatments meta-analysis. BMJ Open. 2017;7(8):e016499. doi: 10.1136/bmjopen-2017-016499

31. Bai ZF, Wang LY. Efficacy of sertraline for post-stroke depression: A systematic review protocol of randomized controlled trial. Medicine (Baltimore). 2019 Apr;98(16):e15299. doi: 10.1097/MD.0000000000015299

32. Winstein CJ, Stein J, Arena R, et al. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association [published correction appears in Stroke. 2017 Feb;48(2):e78] [published correction appears in Stroke. 2017 Dec;48(12):e369]. Stroke. 2016;47(6):e98-e169. doi: 10.1161/STR.0000000000000156

33. Huang J, Zhou FC, Guan B, et al. Predictors of Remission of Early-Onset Poststroke Depression and the Interaction Between Depression and Cognition During Follow-Up. Front Psychiatry. 2019 Jan 8;9:738. doi: 10.3389/fpsyt.2018.00738. eCollection 2018.

34. Frampton JE. Vortioxetine: A Review in Cognitive Dysfunction in Depression. Drugs. 2016 Nov;76(17):1675-82. doi: 10.1007/s40265-016-0655-3


For citations:

Kotov S.V., Isakova E.V., Egorova Yu.V. Post-stroke depression and the abilities of antidepressants to enhance the effectiveness of neurorehabilitation. Neurology, Neuropsychiatry, Psychosomatics. 2020;12(6):110-116. (In Russ.)

Views: 456

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)