Although post-stroke depression occurs with lesions to either cortical hemisphere, increasing evidence supports the view that depression is more prevalent after left hemispheric damage. This retrospective study of depressed post-stroke inpatients referred for psychiatric consultation shows a significantly higher referral rate for patients with right-hemispheric lesions. The results suggest an underutilization of psychiatric consultation to patients with left-sided lesions, and perhaps underrecognition of affective disorders in these patients. Various reasons for this underutilization are proposed, including the greater likelihood of speech impairment in left-sided brain-damaged stroke patients, who may have greater difficulty verbally communicating their psychic distress. Increased physician awareness of the clinical presentations of post-stroke depression will result in more patients benefitting from available treatments.