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Two cases of emotional disorder after middle cerebral artery infarction showing distinct responses to antidepressant treatment

Authors Shimoda K, Kimura M

Received 28 February 2014

Accepted for publication 9 April 2014

Published 23 May 2014 Volume 2014:10 Pages 965—970

DOI https://doi.org/10.2147/NDT.S63290

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Kengo Shimoda, Mahito Kimura

Nippon Medical School Department of Psychiatry, Nippon Medical School, Chiba Hokusou Hospital, Chiba, Japan

Abstract: Many emotional disturbances such as post-stroke depression (PSD) and emotional incontinence (EI) commonly occur following cerebrovascular events. The efficacy of antidepressants for these conditions has been established but their comorbid treatment has not been well characterized. In the current study, the authors describe two cases of post-stroke emotional dysregulation; one case with EI; and the other with EI complicated by PSD. The authors describe their differential responses to treatment. Case 1 developed EI after an infarct due to occlusion of the penetrating branches of the left middle cerebral artery (MCA). Case 2 developed both PSD and EI after right MCA stem occlusion. Both patients were initially treated with the selective serotonin reuptake inhibitor (SSRI) paroxetine. Case 1 reacted promptly to SSRI treatment. However, Case 2 had only a partial response to paroxetine, even after many months of treatment. Adjunctive therapy with low-dose aripiprazole was eventually added, resulting in complete improvement of both EI and PSD after 2 additional months of treatment. Thus, Case 2 required a different treatment strategy than Case 1. These findings suggest that aripiprazole adjunctive therapy could be effective for some complex post-stroke emotional disorders.

Keywords: post-stroke disorder, post-stroke depression, emotional incontinence, antidepressants, aripiprazole adjunctive therapy

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