Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson); Mental Health Service Line, Michael E. DeBakey Veterans Affairs Medical Center, and Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Jorge); Department of Psychiatry, University of Western Australia, Perth, Australia (Starkstein).
J Neuropsychiatry Clin Neurosci. 2024 Winter;36(1):22-35. doi: 10.1176/appi.neuropsych.21090231. Epub 2023 Aug 10.
The presence of neuropsychiatric disorders after stroke has been recognized for more than 100 years, but controlled systematic studies did not begin until the 1970s. The most clinically important advances, however, have been in the treatment and prevention of poststroke depression (PSD). Recent meta-analyses of randomized controlled trials (RCTs) for the treatment of PSD have demonstrated the efficacy of antidepressants. Similarly, RCTs for the prevention of PSD have shown that antidepressants significantly decrease the incidence of PSD compared with placebo. Early treatment of PSD with antidepressants also appears to enhance both physical and cognitive recovery from stroke and may increase survival up to 10 years. Genetic and epigenetic variations, white matter disease, cerebrovascular deregulation, altered neuroplasticity, and changes in glutamate neurotransmission may be relevant etiological factors.
脑卒中后出现神经精神障碍已有 100 多年的历史，但直到 20 世纪 70 年代才开始进行对照系统的研究。然而，在脑卒中后抑郁（PSD）的治疗和预防方面取得了最具临床意义的进展。最近对 PSD 治疗的随机对照试验（RCT）的荟萃分析表明，抗抑郁药有效。同样，预防 PSD 的 RCT 表明，与安慰剂相比，抗抑郁药可显著降低 PSD 的发生率。早期用抗抑郁药治疗 PSD 似乎还可以促进脑卒中后的身体和认知恢复，并且可能提高 10 年的生存率。遗传和表观遗传变异、白质疾病、脑血管调节异常、神经可塑性改变以及谷氨酸神经递质传递改变可能是相关的发病因素。
