The biopsychosocial storm of post-stroke depression: An update on recent advances in mechanisms and treatment

Post-stroke depression (PSD) is associated with disruption to frontostriatal networks, including functional connectivity in regions relevant for cognitive control and emotion regulation. These neurobiological changes are accompanied by emotional and psychosocial stress that altogether contribute to the heterogeneous symptom presentation of PSD. PSD has circuit changes that overlap with executive dysfunction, suggesting that novel therapeutic strategies may address both mood and cognitive symptoms post-stroke. Psychotherapy for PSD focuses on helping patients regulate emotions, engage in activities, and reframe negative thoughts while also addressing the effects on the family, caregivers, and patient’s environment. Ecosystem-Focused Therapy is efficacious for PSD but the effect varies based on the presence of executive dysfunction. Pharmacologic treatment can be effective in treating ongoing symptoms and in prophylaxis, but must be considered in the context of side-effects, impact on cognition, and impact on stroke functional recovery.