Response of emotional unawareness after stroke to antidepressant treatment

Objective: Unawareness of impairment (anosognosia) is a phenomenon associated with right hemisphere lesions. Unawareness of emotion has rarely been studied. Methods: Patients (N = 50) with poststroke major depression were administered the Toronto, Ontario, Canada, Alexithymia Scale to assess impairment in identifying feelings (F1), describing feelings (F2), and externally oriented thinking (F3). After eight weeks of treatment with sertraline or fluoxetine, patients were reassessed. Results: Alexithymia was significantly associated with right hemisphere lesions. Patients with alexithymia had a significant improvement in identifying and describing feelings, but not in externally oriented thinking. In addition, cognitive functions improved after antidepressant treatment in patients without alexithymia with left lesions only. On the contrary, functional activities of daily living and depressive symptoms improved both in patients with alexithymia and those without alexithymia. Conclusions: The unawareness of emotions is a common impairment after right hemisphere stroke. This disorder may be significantly improved by antidepressant treatment.