The role of psychotherapy in the prevention and treatment of post-stroke depression

Depression is the most common psychiatric complication of stroke. Its occurrence correlates i.a. with delayed rehabilitation process, more severe cognitive disabilities and deterioration of patients' quality of life. The majority of articles on the prevention or management of depression after stroke focus on pharmacological treatment, overlooking psychotherapy. As a modality of treatment indicated for patients with mild to moderate depression, psychotherapy seems to be a good proposition for stroke survivors, because of the predominant prevalence of these forms of depression in this population. Even though psychotherapy may be difficult if not impossible to perform in a significant percentage of patients, e.g. those with a severe neurological status, or impairment of higher cognitive functions (aphasia, dementia), there are many stroke patients with a milder course of the disease, potentially eligible for this form of prevention or treatment of depression. In the light of evidence-based medicine, psychotherapy has been shown to have only a preventive, not therapeutic effect in stroke patients. However, the variety of the approaches used often renders reports impossible to compare with each other, hence conclusions should be made with great caution. The paper reviews selected studies and suggested forms of therapy. According to the results of the studies, simpler forms of psychotherapy, closest to psychoeducation or even support groups and focusing on the patient's everyday problems, appear more suited to the needs of stroke individuals. For the time being, and probably for a long time to come, it remains unclear which of the methods is the most appropriate. Considering the size of the stroke population, however, and the potential lack of adequate pharmacotherapy as well as the ethical doubts surrounding the prophylactic administration of psychotropic drugs, psychotherapy seems to be associated with a useful potential for the prevention and treatment of post-stroke depression.