Exploring Individualized Diagnosis and Treatment for Post-Stroke Depression Based on Neurotransmitter Atlas: A Report of Two Cases

doi:10.3969/j.issn.1673-5765.2026.01.012

Abstract

Abstract: Post-stroke depression (PSD) patients often exhibit significantly reduced 5-hydroxytryptamine (5-HT) levels. This alteration is closely associated with stroke-induced disruption of neural pathways and metabolic abnormalities. Serotonin-selective reuptake inhibitors (SSRIs), such as sertraline, the first-line antidepressant drugs, selectively inhibit presynaptic 5-HT reuptake, thereby increasing synaptic 5-HT concentrations. This case report describes two cases of ischemic PSD. Using molecular imaging techniques, the stroke lesions and affected nuclei were mapped onto 5-HT receptor/transporter density atlases, and accordingly identified presynaptic and postsynaptic injury subtypes. The results showed that the two patients presented with presynaptic injury and postsynaptic injury, respectively, suggesting that different PSD subtypes may exhibit differential response to sertraline in antidepressant treatment. This case report provides novel insights for developing precise diagnostic subtypes and individualized treatment strategies for PSD.

Key words: Ischemic stroke; Post-stroke depression; Neurotransmitter mapping; Molecular imaging; Case report

摘要： 卒中后抑郁（post-stroke depression，PSD）患者体内的5-羟色胺（5-hydroxytryptamine，5-HT）水平常显著下降，这一变化与卒中病灶对神经通路的破坏及代谢异常等因素密切相关。5-羟色胺选择性再摄取抑制剂（serotonin-selective reuptake inhibitors，SSRIs），如舍曲林，可选择性抑制突触前膜5-HT再摄取，提高突触间隙5-HT浓度，是目前抗抑郁治疗的一线药物。本病例报道2例缺血性PSD患者，通过分子影像学技术，将其病灶与受累核团映射至5-HT受体/转运体密度图谱，据此区分出突触前与突触后损伤两种亚型，结果显示2例患者分别为突触前及突触后损伤，提示不同PSD亚型可能对舍曲林抗抑郁治疗存在差异反应。本病例报道为探索PSD精准诊断分型及个体化治疗策略提供了新思路。

关键词: 缺血性卒中; 卒中后抑郁; 神经递质映射; 分子影像学; 病例报道

CLC Number:

ZHANG Zhijie, ZHANG Hua, WEI Jingpei, QIAN Xunqi, ZHAO Zijun. Exploring Individualized Diagnosis and Treatment for Post-Stroke Depression Based on Neurotransmitter Atlas: A Report of Two Cases[J]. Chinese Journal of Stroke, 2026, 21(1): 105-112.

张之婕, 张华, 卫景沛, 钱勋琦, 赵子珺. 基于神经递质图谱的卒中后抑郁患者个体化诊疗探索——2例病例报道[J]. 中国卒中杂志, 2026, 21(1): 105-112.

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