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Depression Guidelines

Learning objectives

  • Learning
  • Understand
  • Integrate
  • Reflect

Link to RCP Stroke Guidelines 2016
  • People with stroke with one mood disorder (e.g. depression) should be assessed for others (e.g. anxiety).
  • People with or at risk of depression or anxiety after stroke should be offered brief psychological interventions such as motivational interviewing or problem-solving therapy (adapted if necessary for use with people with aphasia or cognitive problems) before considering antidepressant medication.
  • People with mild or moderate symptoms of psychological distress, depression or anxiety after stroke should be given information, support and advice and considered for one or more of the following interventions: increased social interaction; increased exercise; other psychosocial interventions such as psychosocial education groups.
  • People with aphasia and low mood after stroke should be considered for individual behavioural therapy e.g. from an assistant psychologist.
  • People with depression or anxiety after stroke who are treated with antidepressant medication should be monitored for adverse effects and treated for at least four months beyond initial recovery. If the person's mood has not improved after 2-4 weeks, medication adherence should be checked before considering a dose increase or a change to another antidepressant.
  • People with severe or persistent symptoms of emotional disturbance after stroke should receive specialist assessment and treatment from a clinical neuropsychologist/clinical psychologist.
  • People with persistent moderate to severe emotional disturbance after stroke who have not responded to high intensity psychological intervention or pharmacological treatment should be considered for collaborative care. Their care should involve collaboration between the GP, primary and secondary physical health services and case management, with supervision from a senior mental health professional and should include long term follow-up.