Previous literature has shown that depression is the most common major emotional result following a stroke. Although the prevalence and severity of this issue have been well documented, limited research has been done to identify the evolution of post-stroke depressive symptoms in the acute phase following a stroke. During this period of time, the patient is faced with a number of significant changes from his / her previous level of functioning. These issues can include loss of physical functioning, loss of independence, changes in living arrangements, and an increased reliance on the support and care of others. The purpose of the current study was to examine fluctuations in depressive symptoms as each participant progressed through rehabilitation and discharge, and to gather qualitative information pertaining to the contributing factors that could play a role in this issue. A sample of nine participants between the ages of 50 and 85 was obtained from a regional rehabilitation unit. Data and clinical information were collected using an intensive case study design. Participants were asked to complete the Geriatric Depression Scale (GDS) at three-day intervals while on the rehabilitation unit and following discharge. This information was interpreted in the context of qualitative information gathered through reports from the participant, his or her significant other / family member, nursing and professional staff members on the rehabilitation unit, and patient records. Other analyses performed included an examination of the interactions between performance and motivation during the rehabilitation process and role of discharge site in the development and course of depressive symptoms. When examined as a whole, the information collected across all nine participants would suggest that following discharge there was a statistically significant increase in the level of post-stroke depressive symptoms. While the individuals were on the rehabilitation unit, the depressive symptoms decreased significantly and this trend continued following discharge, but the slope was not as significant as that which was observed on the rehabilitation unit. The results also suggested that there is a significant difference between the progression of depressive symptoms between groups separated based on discharge site.

Post-stroke depression (PSD) is highly prevalent and has a significant impact on stroke patients’ recovery. The systematic review aimed to build on previous review evidence to investigate the effectiveness of psychosocial interventions on reducing depression levels post-stroke. Multiple electronic databases were searched using a combination of keywords related to depression, stroke and psychosocial interventions. Randomised controlled trials investigating the effect of psychosocial interventions on depression levels for adult stroke patients were included. Methodological quality of included studies was assessed using criteria developed by the authors. Sixteen studies were included, four of which found a significant benefit of psychosocial interventions over control conditions on mood. While the results suggest some psychosocial interventions may be effective in reducing depression post-stroke; confidence in these findings is limited due to methodological limitations within studies. The review identified a number of methodological limitations across all included studies which may explain why previous research has not found any benefit of psychosocial interventions for PSD. Therefore, the evidence base is currently insufficient and further research which utilises a robust methodology is needed before any reliable conclusions can be drawn regarding the effectiveness of psychosocial interventions for PSD. The empirical study aimed to explore participants’ experiences of an Interpersonal Psychotherapy (IPT) assessment and formulation post-stroke to investigate the acceptability of using this model with patients experiencing PSD and indicate if more detailed quantitative research is justified. Ten participants with post-stroke depression (PSD) received two assessment appointments with a Clinical Psychologist, generating an IPT formulation of their difficulties. Participants subsequently took part in a semi-structured interview about their experience of this process. The results of these interviews were transcribed and analysed using Framework Analysis. Participants were seen to link their difficulties post-stroke to three of the four IPT interpersonal focus areas; interpersonal disputes, role transitions and grief loss. Overall, participants found an IPT assessment and formulation to be acceptable and identified benefits of the sessions including: altering their viewpoint, increasing acceptance of impaired functioning, reducing frustration, increasing positive feelings and leading to improvements in their social support. IPT may therefore be a suitable intervention for PSD and further robust, quantitative research is justifiable. Results suggest acceptance and an altered viewpoint are common following an IPT assessment and formulation; therefore future IPT research should measure changes in these variables alongside mood and behaviour.

The study evaluated whether the activity of the indoleamine 2,3 dioxygenase (IDO) enzyme is increased post-stroke and contributes to the development of post-stroke depression (PSD) via tryptophan (TRP) depletion and neurotoxic kynurenine (KYN) metabolite production. The activity of IDO was measured using the KYN/TRP ratio. Participants were assessed for depression severity using the Center for Epidemiological Studies Depression Scale (CES-D). Blood TRP, KYN, large neutral amino acids and cytokines were measured and compared. Fifty-four (mean age=69.9±15.2, male=52.7%, mean NIHSS=7.3±4.6) patients within 28.9±40.3 days of stroke were separated into two groups: non-depressed (n=38, CES-D=6.1±4.9) and those with significant depressive symptoms (n=16, CES-D=26.8±10.8). Higher mean KYN/TRP ratios were demonstrated in stroke patients with depressive symptoms (non-depressed=69.3±36.9 vs. depressive symptoms=78.3±42.0, F3,50=4.61, p=0.006) after controlling for LNAA (p=0.026) and hypertension (p=0.039). As the KYN/TRP ratio reflects decreased TRP and increased neurotoxic KYN metabolites, both mechanisms may play an etiological role in PSD.

The study evaluated whether the activity of the indoleamine 2,3 dioxygenase (IDO) enzyme is increased post-stroke and contributes to the development of post-stroke depression (PSD) via tryptophan (TRP) depletion and neurotoxic kynurenine (KYN) metabolite production. The activity of IDO was measured using the KYN/TRP ratio. Participants were assessed for depression severity using the Center for Epidemiological Studies Depression Scale (CES-D). Blood TRP, KYN, large neutral amino acids and cytokines were measured and compared. Fifty-four (mean age=69.9±15.2, male=52.7%, mean NIHSS=7.3±4.6) patients within 28.9±40.3 days of stroke were separated into two groups: non-depressed (n=38, CES-D=6.1±4.9) and those with significant depressive symptoms (n=16, CES-D=26.8±10.8). Higher mean KYN/TRP ratios were demonstrated in stroke patients with depressive symptoms (non-depressed=69.3±36.9 vs. depressive symptoms=78.3±42.0, F3,50=4.61, p=0.006) after controlling for LNAA (p=0.026) and hypertension (p=0.039). As the KYN/TRP ratio reflects decreased TRP and increased neurotoxic KYN metabolites, both mechanisms may play an etiological role in PSD.

Aims: a review of the literature on non-pharmacological interventions for post-stroke depression (PSD) was completed with the aim of examining issues regarding the design and methodology of trials for non-pharmacological interventions for PSD. The empirical research study used a constructivist Grounded Theory approach to explore specialist stroke professionals' conceptualisations of post-stroke emotional lability (PSEL). The author also aimed to examine how staff experienced, understood and identified PSEL in clinical practice, and particularly how they differentiated it from PSD. Method: A systematic review of RCT and non-RCT studies was conducted to address the first aim. In relation to the second aim, a qualitative investigation of specialist professionals' conceptualisations of PSEL was conducted using Charmaz' (2006) version of constructivist Grounded Theory. Results: The systematic review highlighted the importance of appropriate sampling methods, multiple treatment design, rigorous data collection, the implementation and monitoring of interventions, assessment of participant suitability for the intervention, and issues related to long-term sustainability (follow-up) when designing and evaluating non-pharmacological interventions for PSD. The qualitative investigation yielded a conceptual model of how specialist professionals conceptualise and identify PSEL in their clinical practice. Conclusions and implications: The findings from the systematic review and the qualitative investigation highlighted a range of issues for specialist stroke services. The systematic review emphasised the importance of further evaluation and consideration of carefully planned randomised controlled trials for investigating non-pharmacological interventions for PSD. The qualitative study indicated a need for further guidance on the assessment and identification of PSEL, training for staff, and further examination of the caused of PSEL.

This cross-sectional study examined neurobiologic correlates of depression in ischemic stroke patients. Depression severity was measured with a standardized scale (Center for Epidemiologic Studies Depression Scale; CES-D). Eighty-two patients (53.1% male, mean (± SD) age 71.9 ± 14.2 years, mean (± SD) National Institutes of Health Stroke Scale (NIHSS) score 4.6±4.7, mean (± SD) CES-D score 12.6 ± 10.8) were recruited. A linear regression controlling for age and stroke severity (NIHSS) determined that the kynurenine to tryptophan ratio (β= -0.105, p=0.369) was not significantly associated with CES-D (primary hypothesis) (overall model R2=0.069, F3,73=1.805, p=0.154). Secondary analyses suggested one instance of cytokines favouring inflammatory states in mild depressive symptomatology; IFN-Ɣ/IL-10 (OR, 2.17; 95% CI, 1.02-4.64, p=0.045). For the most part however, inclusion of cytokines and neuroimaging correlates such as atrophy, lesion location and white matter changes were non-significant. Longitudinal studies are necessary to identify the possible neurobiologic correlates of depressive symptoms post-stroke.

This cross-sectional study examined neurobiologic correlates of depression in ischemic stroke patients. Depression severity was measured with a standardized scale (Center for Epidemiologic Studies Depression Scale; CES-D). Eighty-two patients (53.1% male, mean (± SD) age 71.9 ± 14.2 years, mean (± SD) National Institutes of Health Stroke Scale (NIHSS) score 4.6±4.7, mean (± SD) CES-D score 12.6 ± 10.8) were recruited. A linear regression controlling for age and stroke severity (NIHSS) determined that the kynurenine to tryptophan ratio (β= -0.105, p=0.369) was not significantly associated with CES-D (primary hypothesis) (overall model R2=0.069, F3,73=1.805, p=0.154). Secondary analyses suggested one instance of cytokines favouring inflammatory states in mild depressive symptomatology; IFN-Ɣ/IL-10 (OR, 2.17; 95% CI, 1.02-4.64, p=0.045). For the most part however, inclusion of cytokines and neuroimaging correlates such as atrophy, lesion location and white matter changes were non-significant. Longitudinal studies are necessary to identify the possible neurobiologic correlates of depressive symptoms post-stroke.

Stroke är ett akut och livshotande tillstånd som drabbar cirka 30 000 människor i Sverige varje år. Stroke kan leda till fysisk och kognitiv nedsättning men även till psykiska symptom som depression och nedstämdhet. Syftet med studien är att beskriva hur sjuksköterskan kan identifiera strokerelaterad depression samt att främja hälsa hos dessa patienter. Litteraturstudien baseras på en kvalitativ och åtta kvantitativa artiklar som beskriver hur sjuksköterskan i mötet med patienten kan förbättra hälsa. För att sjuksköterskan ska kunna identifiera patienter som drabbats eller ligger i riskzonen för att drabbas av post stroke depression (PSD), studerades olika screeninginstrument, som skulle kunna vara användbara för att identifiera PSD. Många instrument var inte tillrättalagda för att kunna användas på patienter med kognitiv nedsättning, vilket flertalet av de strokedrabbade har. Tidigare kardiovaskulär sjukdom och psykisk ohälsa sågs som en risk för att drabbas av PSD. PSD ger en skadlig påverkan på både den fysiska och den psykiska hälsan, vilket i förlängningen ger en negativ inverkan på livskvaliteten. Socialt stöd från sjuksköterskan främjade livskvalitet hos patienten och dess närstående. Om strokerelaterad depression i ett tidigt skede uppmärksammas och behandlas, så kan den fysiska rehabiliteringen ge ett bättre resultat och därmed förbättra patientens hälsa. Ett problem som sjuksköterskan möter då hon ska identifiera PSD, är tidsbristen i vården, då det ofta krävs en mer tät kontakt för att kunna uppmärksamma skillnader i patientens hälsa. Sjuksköterskan bör inta en lyhörd och följsam roll för att se patientens livsvärld och det som inkluderas i den, så som de närstående och patientens sociala aktiviteter.

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Cerebrovascular disease is a leading cause of disability and death worldwide, with about one third of stroke survivors initially suffering from communication disorders, including aphasia. Symptoms in aphasia vary from person to person, ranging from repeated failures in verbal expression to comprehension deficits that may occur in both the spoken and written modality. The current work synthesizes almost a decade of research on aphasia following left-hemispheric stroke in individuals with preserved right-hemispheric function: musical skills and formulaic expressions embedded in social interaction. Moving beyond the traditional scope of clinical linguistics, this work argues that preserved right-hemispheric function not only provides valuable resources in speech-language therapy, but also a possible foundation for psychotherapy in individuals with post-stroke aphasia and concomitant depression. An integrative summary introduces key developments in a line of research spanning from 2013 to 2021, to conclude with an outlook on forthcoming contributions and a commentary on the underlying conceptual framework. Each separate piece of research has been published previously in peer-reviewed journals. Here, the selected studies are assembled in an interdisciplinary context at the intersection of clinical neuroscience, speech-language pathology, and psychotherapy.