Depression is a heterogeneous group of conditions and a clinical diagnosis without external validators. Diagnosis of depression in the setting of disorders that produce psychomotor retardation and changes in vegetative function can be particularly challenging. This review aims to emphasise the importance of depressive symptoms and syndromes in the overall wellbeing of people with neurological disorders, and to equip clinicians with the practical skills to recognise and treat depression effectively.
The evidence base for the treatment of depression in neurological disorders is inadequate. Therefore much of the advice on treatment is based on clinical consensus and experience with treatments in other settings (that is, in the treatment of idiopathic depressive syndromes). Controlled trials of treatments for depression in this setting are urgently needed.
DEPRESSION IN PARKINSON’S DISEASE
Diagnosis and management of depression in Parkinson’s disease (PD) is important for two main reasons: firstly, depression is common in PD (see details on prevalence below), and secondly depression causes significant morbidity in terms of quality of life, disability (measured by activities of daily living), and carer stress. This effect is independent from the effect of motor disability.
DEPRESSION AND STROKE
Stroke is characterised by sudden injury (often with consequent multiple loss of function) followed by a recovery phase. Injury tends to be focal. This leads to a different spectrum of neuropsychiatric problems when compared to inflammatory or neurodegenerative conditions.
There are three main reasons why people are at increased risk of depression following stroke:
They often suffer sudden, multiple loss events (loss of physical function, employment, change in social or marital status)
They may lose the neurological capacity to process these loss events
Stroke may affect areas of the brain directly involved in control of mood.