WSC 2025 | The prevalence and pathophysiology of post-stroke depression and anxiety

So post-stroke depression and anxiety is very common. So it can range from 5% to 85% depending on the timing of evaluation. So the average is 30%. So if you do the assessment during the first five days, it can be about 5%. But if you do a reassessment at the third month post-stroke, it can be 85%, so it can affect the quality of life of the patient, it can affect rehabilitation because they’re so depressed and too anxious, so they don’t want to go to rehabilitation. It affects their activities of daily living, increases mortality for stroke. So that’s it. So looking at the prevalence with stroke in the young and elderly population, if you look at stroke in the young, the post-stroke depression is 30%, but the anxiety is even higher, about 38% to even 45%, because they’re still young, meaning their age group is 18 to 55-year-old. So they’re too anxious about their future. So anxiety is high, but the depression is 30%. So looking at the pathophysiology of depression, it is multimodal. There are a lot of pathways. There can be glutamate excitability, increase in glutamate, neuroinflammation in the brain, systemic inflammation. Even the gut-brain axis, the connection between the gut and the brain is affected, meaning if there’s stress, there’s a change in gut microbiota, and it causes neuroinflammation to the brain also. So there’s reduction of monoamines, meaning the serotonin, dopamine, norepinephrine, and also there’s a dysregulation of the HPA axis. So all these conditions can cause depression.

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