Pathopysiological mechanisms in post-stroke depression. Psychosocial and economic implication of patient rehabilitation
Pathopysiological mechanisms in post-stroke depression. Psychosocial and economic implication of patient rehabilitation

Summary/Abstract: A stroke is an acute loss of cerebral function caused by the stenosis, occlusion or rupture of an artery in the brain, resulting from a variety of predisposing factors. Depression and fatigue are the most common psychiatric complications after stroke, many researchers associating the two. Furthermore, if norepinephrine, serotonin and dopamine are func-tionally altered, the nervous system is also affected, contributing to changes in emotional regulation and the pathogenesis of depression. Regarding the localization of the lesions, infarcts of the basal ganglia, the corona radiata and the internal capsule were randomly associated with the emergence of fatigue at three months after the stroke, while injuries that occurred in the cerebellum showed no associa-tion with it. Inflammation, cognitive disturbances and depression are distinctive characteristics that occur after a stroke. To alleviate their clinical expression, many researchers have studied ways to control these phenomena. The inflammatory hypothesis stipulates that depression is associated with the increase of pro-inflammatory cytokines and acute phase proteins. The presence of depressive symptoms is not only a negative prognostic factor in patients with known cardiovascular disease but may also precipitate cardiovascular disturbances in healthy individuals. Moreover, several other elements, such as the vascular endothelial growth factor (VEGF), the fibroblast growth factor-2 (FGF-2) and insulin-like growth fac-tor-I have been associated with the onset of major depressive disorder. The vascular hy-pothesis posits that the small lesions that disrupt important neural pathways can also pre-cipitate the occurrence of depression. Considering that stroke is a condition that implies neurological dysfunctions of various impact degree, coping mechanisms, and an early recognition and management of depres-sion become key psychological resources in the process of recovery.

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