Lin MC, Huang SS. Diagnosis and etiology of poststroke depression: A review. World J Psychiatry 2025; 15(7): 107598 [DOI: 10.5498/wjp.v15.i7.107598]
Corresponding Author of This Article
Si-Sheng Huang, MD, Division of Geriatric Psychiatry, Department of Psychiatry, Changhua Christian Hospital, No. 135 Nanhsiao Street, Changhua 500, Taiwan. 97278@cch.org.tw
Research Domain of This Article
Geriatrics & Gerontology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Psychiatry. Jul 19, 2025; 15(7): 107598 Published online Jul 19, 2025. doi: 10.5498/wjp.v15.i7.107598
Diagnosis and etiology of poststroke depression: A review
Meng-Chan Lin, Si-Sheng Huang
Meng-Chan Lin, Department of Psychiatry, National Cheng Kung University Hospital, Tainan 70403, Taiwan
Si-Sheng Huang, Division of Geriatric Psychiatry, Department of Psychiatry, Changhua Christian Hospital, Changhua 500, Taiwan
Si-Sheng Huang, Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
Author contributions: Lin MC and Huang SS designed the study and interpreted the data; Lin MC drafted the article; Huang SS made critical revisions related to important intellectual content of the manuscript; Lin MC and Huang SS approved the final version of the article to be published.
Conflict-of-interest statement: The authors have no conflicts of interest relevant to this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Si-Sheng Huang, MD, Division of Geriatric Psychiatry, Department of Psychiatry, Changhua Christian Hospital, No. 135 Nanhsiao Street, Changhua 500, Taiwan. 97278@cch.org.tw
Received: March 27, 2025 Revised: April 20, 2025 Accepted: June 3, 2025 Published online: July 19, 2025 Processing time: 105 Days and 20.6 Hours
Abstract
Following an acute stroke, patients often encounter a range of impairments affecting their physical, cognitive, verbal, and social capabilities. Poststroke depression (PSD) has been identified as a significant consequence of stroke and serves as a crucial predictor of patient outcomes. The diagnosis of PSD presents a challenge, as the physical manifestations following a stroke can overlap with certain depressive symptoms, leading to a potential underdiagnosis of this condition. This review employs a narrative approach to synthesize diverse findings within this domain. PSD is categorized as an organic mood disorder, and a more accurate diagnosis may be achieved by considering the location of the stroke, the patient's specific symptoms, and the timeline of depressive symptom onset. Notably, if depressive symptoms emerge at more than one year poststroke, the likelihood of PSD diminishes. The etiology of PSD is currently understood to stem from a combination of physiological and psychosocial factors, as well as their interactions. Several mechanisms associated with PSD have been identified, including inflammation, dysregulation of the hypothalamic-pituitary-adrenal axis, oxidative stress, autophagy, apoptosis, abnormal neurotrophic responses, glutamate-mediated excitotoxicity, dysfunction within brain networks, reduced monoamine levels, locations of brain lesions, and psychosocial influences. This review also outlines potential directions for future research.
Core Tip: Patients who have suffered stroke exhibit a higher rate of depression than do other patients with similar levels of disability. This phenomenon suggests an association between stroke and poststroke depression (PSD). Clinical challenges are encountered in diagnosing PSD, as the cognitive and physical impairments resulting from stroke can interfere with the assessment of depressive symptoms. PSD is currently believed to be the result of physiological and psychosocial factors. It is speculated that the mechanisms underlying the depressive symptoms that arise after a stroke are primarily physiological in the early stages and are later related to psychosocial factors.
