bekhterevОбозрение психиатрии и медицинской психологии имени В.М.БехтереваV.M. BEKHTEREV REVIEW OF PSYCHIATRY AND MEDICAL PSYCHOLOGY2313-70532713-055XV. M. BEKHTEREV NATIONAL RESEARCH MEDICAL CENTER FOR PSYCHIATRY AND NEUROLOGY OF THE RUSSIAN FEDERATION MINISTRY OF HEALTHbekhterev-106Research ArticleПРОБЛЕМНЫЕ СТАТЬИPROBLEM-S0LVING ARTICLESПостинсультная депрессия: диагностические трудности и терапевтические перспективыPost-stroke depression: diagnostic difficulties and treatment perspectivesМальцевСергей ЮрьевичMaltcevS. Iu.spasticarm@gmail.comМихайловВладимир АлексеевичMikhailovV. A.vladmikh@yandex.ruМазоГалина ЭлевнаMazoG. E.galina-mazo@yandex.ruЛукинаЛариса ВикторовнаLukinaL. V.larisalu@yandex.ruФГБУ «Национальный медицинский исследовательский центр психиатрии и неврологии им. В.М. Бехтерева» МЗ РФРоссияV.M. Bekhterev’ National research medical center of psychiatry and neurologyRussian Federation201719072018041317Copyright © Мальцев С.Ю., Михайлов В.А., Мазо Г.Э., Лукина Л.В., 20182018Мальцев С.Ю., Михайлов В.А., Мазо Г.Э., Лукина Л.В.Maltcev S.I., Mikhailov V.A., Mazo G.E., Lukina L.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.bekhterevreview.com/jour/article/view/106

Множество проведенных исследований указывает на тот факт, что постинсультная депрессия представляет из себя сложную, многогранную медико-социальную проблему, бросающую вызов системе реабилитации. Решение этой задачи, безусловно, требует применения четкого диагностического инструментария и самых современных терапевтических подходов. В то же время, существуют некоторые аспекты, которые не позволяют в полной мере достичь ожидаемых результатов реабилитации. В данной статье нами рассмотрены как недостатки в современной системе диагностики постинсультной депрессии, так и некоторые из наиболее перспективных диагностических и терапевтических методик, которые призваны помочь в решении этой проблемы.

A plenty of studies show that the post- stroke depression is a difficult and complex problem, which bids defiance to the whole rehabilitation system. The solution of this objective definitely needs some specific diagnostic utilities and the most actual treatment methods. At the same time, there are some reasons, which do not allow us to reach an optimal rehabilitation result. In our paper we are reviewing both diagnostic problems of a post- stroke depression and some of the most promising diagnostic and treatment techniques, and hope that will help us solving an issue.

Постинсультная депрессиятранскраниальная магнитная стимуляцияантидепрессантыреабилитацияPost-stroke depressiontranscranial magnetic stimulationantidepressantsrehabilitationReferencesБогданов А.Н., Добрынин Ю.В., Добрынина И.Ю., Сонина С.Н. Эпидемиология, факторы риска и организация неотложной помощи при ишемическом инсульте в городском центре севера Западной Сибири (опыт 20-летнего изучения). - Неврология, нейропсихиатрия, психосоматика. - 2014. - C. 28-33.Богданов А.Н., Добрынин Ю.В., Добрынина И.Ю., Сонина С.Н. Эпидемиология, факторы риска и организация неотложной помощи при ишемическом инсульте в городском центре севера Западной Сибири (опыт 20-летнего изучения). - Неврология, нейропсихиатрия, психосоматика. - 2014. - C. 28-33.Бойцов С.А., Чучалин А.Г. Профилактика хронических неинфекционных заболеваний- методические рекомендации. - М.: МЗ РФ. - 2013. -128 с.Бойцов С.А., Чучалин А.Г. Профилактика хронических неинфекционных заболеваний- методические рекомендации. - М.: МЗ РФ. - 2013. -128 с.Вейн А.М., Вознесенская Т.Г., Голубев В.Л. Депрессия в неврологической практике. 3-е изд. - М.: МИА. - 2007. -197 с.Вейн А.М., Вознесенская Т.Г., Голубев В.Л. Депрессия в неврологической практике. 3-е изд. - М.: МИА. - 2007. -197 с.Кузнецов А.Н., Скворцова В.И., Стаховская Л.В. Ишемический инсульт и транзиторные ишемические атаки. Клинические рекомендации. Неврология и нейрохирургия. [под. ред. Гусева Е.И., Коновалова А.Н., Гехт А.Б.]. - М.: ГЭОТАР-Медиа. - 2007. - С. 129-177.Кузнецов А.Н., Скворцова В.И., Стаховская Л.В. Ишемический инсульт и транзиторные ишемические атаки. Клинические рекомендации. Неврология и нейрохирургия. [под. ред. Гусева Е.И., Коновалова А.Н., Гехт А.Б.]. - М.: ГЭОТАР-Медиа. - 2007. - С. 129-177.Каннер А.М. Депрессия при неврологических заболеваниях. - М.: Литтерра. - 2007. - 159с.Каннер А.М. Депрессия при неврологических заболеваниях. - М.: Литтерра. - 2007. - 159с.Alajbegovic A., Djelilovic-Vranic J., Alajbegovic S. - Post Stroke Depression Med Arch. - 2014. - Vol. 68. - C. 47-50.Alajbegovic A., Djelilovic-Vranic J., Alajbegovic S. - Post Stroke Depression Med Arch. - 2014. - Vol. 68. - C. 47-50.Appleton K. M., Rogers, P. J., Ness, A. R. Updated systematic review and meta-analysis of the effects of n-3 long-chain polyunsaturated fatty acids on depressed mood. - Am.J.Clin Nutr. - Vol. 91. - C. 757-770.Appleton K. M., Rogers, P. J., Ness, A. R. Updated systematic review and meta-analysis of the effects of n-3 long-chain polyunsaturated fatty acids on depressed mood. - Am.J.Clin Nutr. - Vol. 91. - C. 757-770.Berlim M.T., Daskalakis Z.J. Clinically Meaningful Efficacy and Acceptability of Low-Frequency Repetitive Transcranial Magnetic Stimulation (rTMS) for Treating Primary Major Depression: A Meta-Analysis of Randomized, Double-Blind and Sham-Controlled Trials. - Neuropsychopharmacol. - 2013. - Vol. 38. - C. 543-551.Berlim M.T., Daskalakis Z.J. Clinically Meaningful Efficacy and Acceptability of Low-Frequency Repetitive Transcranial Magnetic Stimulation (rTMS) for Treating Primary Major Depression: A Meta-Analysis of Randomized, Double-Blind and Sham-Controlled Trials. - Neuropsychopharmacol. - 2013. - Vol. 38. - C. 543-551.Capaldi V.F., Wynn G.H. Emerging strategies in the treatment of poststroke depression and psychiatric distress in patients. - Psychology research and behavior management. - 2010. - C. 109-118.Capaldi V.F., Wynn G.H. Emerging strategies in the treatment of poststroke depression and psychiatric distress in patients. - Psychology research and behavior management. - 2010. - C. 109-118.Carson A.J., MacHale S., Allen K. Depression after stroke and lesion location: a systematic review. - Lancet. - 2000. - Vol.8. - C. 122-126.Carson A.J., MacHale S., Allen K. Depression after stroke and lesion location: a systematic review. - Lancet. - 2000. - Vol.8. - C. 122-126.George S. A., Barnett S. M., Robert C. Y. - Arch Gen Psychiatry. - 1997. - Vol.54. - C. 915-922.George S. A., Barnett S. M., Robert C. Y. - Arch Gen Psychiatry. - 1997. - Vol.54. - C. 915-922.Iso H. Intake of Fish and Omega-3 Fatty Acids and Risk of Stroke in Women’. -JAMA. - 2001. - Vol.285. - C. 304-312.Iso H. Intake of Fish and Omega-3 Fatty Acids and Risk of Stroke in Women’. -JAMA. - 2001. - Vol.285. - C. 304-312.Jie Li, Yan-Dong Zhao, Jun-Wei Zeng, Xiao-Yan Chen. Serum Brain-derived neurotrophic factor levels in post-stroke depression. - J Affect Disord. - 2014. - C. 373-379.Jie Li, Yan-Dong Zhao, Jun-Wei Zeng, Xiao-Yan Chen. Serum Brain-derived neurotrophic factor levels in post-stroke depression. - J Affect Disord. - 2014. - C. 373-379.Jorge R.E., Robinson R.G., Arndt S. Mortality and post-stroke depression: A placebo- controlled trial of antidepressants. - Am J Psychiatry. - 2003. - Vol. 60. - C. 1823-1829.Jorge R.E., Robinson R.G., Arndt S. Mortality and post-stroke depression: A placebo- controlled trial of antidepressants. - Am J Psychiatry. - 2003. - Vol. 60. - C. 1823-1829.Kauhanen M.L., Korpelainen J.T., Hiltunen P. Aphasia, depression, and non-verbal cognitive impairment in ischaemic stroke. Cerebrovasc Dis. - 2000. - Vol.10. - C.455-461.Kauhanen M.L., Korpelainen J.T., Hiltunen P. Aphasia, depression, and non-verbal cognitive impairment in ischaemic stroke. Cerebrovasc Dis. - 2000. - Vol.10. - C.455-461.Kondo T., Kakuda W., Yamada N. Effect of low-frequency rTMS on motor neuron excitability after stroke. - Acta Neurol Scand. - 2013. - C. 26-30.Kondo T., Kakuda W., Yamada N. Effect of low-frequency rTMS on motor neuron excitability after stroke. - Acta Neurol Scand. - 2013. - C. 26-30.Lökk J., Delbar А. Management of depression in elderly stroke patients. - Neuropsychiatric disease treatment. - 2010. - C. 539-549.Lökk J., Delbar А. Management of depression in elderly stroke patients. - Neuropsychiatric disease treatment. - 2010. - C. 539-549.Neau J.P., Ingrand P., Mouille-Brachet C. Functional recovery and social outcome after cerebral infarction in young adults. - Cerebrovascular diseases. -1998. - Vol.8. - C. 296-302.Neau J.P., Ingrand P., Mouille-Brachet C. Functional recovery and social outcome after cerebral infarction in young adults. - Cerebrovascular diseases. -1998. - Vol.8. - C. 296-302.Oladiji J. O., Akinbo S. R., Aina O. F. Risk factors of post-stroke depression among stroke survivors in Lagos, Nigeria. - Aiyejusunle Afr J Psychiatry (Johannesbg). - 2009. - Vol.12. - C. 47-51.Oladiji J. O., Akinbo S. R., Aina O. F. Risk factors of post-stroke depression among stroke survivors in Lagos, Nigeria. - Aiyejusunle Afr J Psychiatry (Johannesbg). - 2009. - Vol.12. - C. 47-51.Osher Y., Belmaker R.H. Omega-3 fatty acids in depression: a review of three studies. - CNS Neuroscience & Therapeutics. - Vol.15. - C. 128-133.Osher Y., Belmaker R.H. Omega-3 fatty acids in depression: a review of three studies. - CNS Neuroscience & Therapeutics. - Vol.15. - C. 128-133.Ouimet M.A., Primeau F., Cole M.G. Psychosocial risk factors in poststroke depression: a systematic review. - Can. J Psychiatry. - 2001. - C. 46.Ouimet M.A., Primeau F., Cole M.G. Psychosocial risk factors in poststroke depression: a systematic review. - Can. J Psychiatry. - 2001. - C. 46.Paolucci S. Epidemiology and treatment of poststroke depression. - Neuropsychiatric Disease and Treatment. - 2008. - Vol.4. - C. 145-154.Paolucci S. Epidemiology and treatment of poststroke depression. - Neuropsychiatric Disease and Treatment. - 2008. - Vol.4. - C. 145-154.Pohjasvaara T., Leppävuori A., Siira I., Vataja R., Kaste M., Erkinjuntti T. Frequency and clinical determinants of poststroke depression. - Stroke. -1998. - Vol.29. - C. 2311-2317.Pohjasvaara T., Leppävuori A., Siira I., Vataja R., Kaste M., Erkinjuntti T. Frequency and clinical determinants of poststroke depression. - Stroke. -1998. - Vol.29. - C. 2311-2317.Poppitt S.D., Howe C.A., Lithander F.E. Effects of moderate-dose omega-3 fish oil on cardiovascular risk factors and mood after ischemic stroke: a randomized, controlled trial. - Stroke. - Vol.40). - C. 3485-3492.Poppitt S.D., Howe C.A., Lithander F.E. Effects of moderate-dose omega-3 fish oil on cardiovascular risk factors and mood after ischemic stroke: a randomized, controlled trial. - Stroke. - Vol.40). - C. 3485-3492.Ramasubbu R. Therapy for prevention of poststroke depression. Expert opinion on pharmacotherapy. - 2011. - C.2177-2187.Ramasubbu R. Therapy for prevention of poststroke depression. Expert opinion on pharmacotherapy. - 2011. - C.2177-2187.Shutter D.J. Quantitative review of the efficacy of slow-frequency magnetic brain stimulation in major depressive disorder. - Psychol Med. -2010. - Vol.40. - C.1789-1795.Shutter D.J. Quantitative review of the efficacy of slow-frequency magnetic brain stimulation in major depressive disorder. - Psychol Med. -2010. - Vol.40. - C.1789-1795.Verdelho A., Henon H. Depressive symptoms after stroke and relationship with dementia: a three-year follow-up study. - Neurology. - 2004. - Vol. 62. - C. 905-911.Verdelho A., Henon H. Depressive symptoms after stroke and relationship with dementia: a three-year follow-up study. - Neurology. - 2004. - Vol. 62. - C. 905-911.Ween J.E. Prophylactic mirtazapine may help to prevent post-stroke depression in people with good cognitive function. - Evid Based Ment Health. - 2005. - Vol.8. - C. 74.Ween J.E. Prophylactic mirtazapine may help to prevent post-stroke depression in people with good cognitive function. - Evid Based Ment Health. - 2005. - Vol.8. - C. 74.Whyte E.M., Mulsant B.H. Post stroke depression: epidemiology, pathophysiology, and biological treatment. - Biol Psychiatry. - 2002. - C. 253-264.Whyte E.M., Mulsant B.H. Post stroke depression: epidemiology, pathophysiology, and biological treatment. - Biol Psychiatry. - 2002. - C. 253-264.Williams L.S., Ghose S.S., Swinde R.W. Depression and other mental health diaognoses increase mortality risk after ischemic stroke. - Am J Psychiatry. - 2004. - Vol. 161. - C. 1090-1095.Williams L.S., Ghose S.S., Swinde R.W. Depression and other mental health diaognoses increase mortality risk after ischemic stroke. - Am J Psychiatry. - 2004. - Vol. 161. - C. 1090-1095.

The authors declare that there are no conflicts of interest present.