Depression and stroke

Strokes are caused when your brain loses its blood supply. This often happens because of a blood clot that is blocking the passage of blood through an artery.

People who’ve had a stroke often report feeling symptoms of depression. Post-stroke depression is the most frequent psychiatric complication of stroke. Almost a third of those who’ve had a stroke develop depression. However, most of cases of depression after stroke aren’t diagnosed. Doctors may overlook checking for depression signs. People who have had a stroke can either hide the symptoms or not be aware of them. A caregiver can give great insight and help identify depression early.

Depression can affect a person’s quality of life. It can also make it more difficult to recover from a stroke. Depression can also increase the risk of cardiovascular disease, which in turn increases the risk of experiencing another stroke. Mortality rates are 10 times higher in people who experience depression after a stroke.

Post-stroke depression can be managed with treatment. Research suggests that mental function is improved in people who are treated for depression.

You’re more likely to have depression after a stroke if you:

  • had a previous mental illness
  • are female
  • had a previous condition that affected how you think, such as a traumatic brain injury
  • had previous functional difficulties, such as those that may be caused by Parkinson’s disease or other neuromuscular disorders
  • live alone

Strokes that cause a high degree of physical disability and neurological problems also raise your risk. For example, if you develop aphasia after a stroke, you’re more likely to become depressed. Aphasia reduces your ability to talk and understand words.

Every case of post-stroke depression can have different symptoms and duration. Most symptoms appear between three to six months after a stroke. However, the onset can be as early as a month and as late as several years after a stroke. This difference in onset times may be due to two factors — biochemical changes that occur in the brain following a stroke and changes in mood and personality that occur over time. The latter may result from:

  • social circumstances, such as loneliness, lack of social interaction
  • genetics
  • limitations in physical and mental abilities following the stroke

If you’re the caregiver of a person who has recently suffered a stroke, watch out for these nine symptoms:

  1. continuous feelings of sadness and anxiety
  2. loss of interest in normally pleasurable activities
  3. feelings of worthlessness and hopelessness
  4. fatigue
  5. difficulty focusing and irritability
  6. disturbed sleep patterns, such as sleeping too much or too little
  7. loss of appetite or overeating
  8. reduced interest in spending time with friends and family
  9. suicidal thoughts

People who have had a stroke may experience other mood changes, such as:

  • anxiety
  • irritability
  • agitation
  • sleep disturbances
  • behavioral changes
  • apathy
  • fatigue
  • hallucinations

It’s important that caregivers are aware of the emotional state of a person who’s had a stroke. This can improve the chances of getting a proper diagnosis.

Doctors diagnose depression based on the criteria listed in the “Diagnostic and Statistical Manual of Mental Disorders.” Depression is diagnosed if a person has experienced at least five of the nine symptoms listed previously for at least two weeks.

Treatment for depression is usually a combination of therapy and medication.

Cognitive behavioral therapy is a common therapy used to treat depression. Common medications used to treat depression include:

  • selective serotonin reuptake inhibitors, such as fluoxetine (Prozac) and paroxetine (Paxil)
  • serotonin-norepinephrine reuptake inhibitors, such as duloxetine (Cymbalta) and venlafaxine (Effexor XR)
  • tricyclic antidepressants, such as imipramine (Tofranil-PM) and nortriptyline (Pamelor)
  • monoamine oxidase inhibitors, such as tranylcypromine (Parnate) and phenelzine (Nardil)

It’s important to understand how these medications can interact with others you might be taking. Be sure to talk to your doctor about possible interactions.

If you’re experiencing post-stroke depression, lifestyle changes such as these might help:

Attend a support group

Through support groups, you can meet others who are going through similar situations. This may help you feel less alone.

Eat a healthy diet

A diet that consists of fruits, vegetables, and lean meats will help you stay healthy and recover.

Be social

Staying social and avoiding social isolation may help you feel less depressed.

Stay as independent as possible

If you’re recovering from a stroke, you may need help from caretakers. It can be very difficult for you to lose personal independence. Work with your caretakers to figure out tasks you can do by yourself.

Exercise every day

Daily physical activity can help speed stroke recovery and treat depression. Walking and other low-impact exercises are good options.

One of the most difficult things that a person who’s had a stroke has to come to terms with is being partially or fully dependent on a caregiver for a while. That kind of challenge, combined with all the other mental and physical limitations caused by the stroke, can increase the risk of depression.

Proper monitoring and seeing a doctor at the first signs of depression can help reduce the severity of the condition and improve the chances of post-stroke recovery. The risk of chronic depression increases if the condition goes undiagnosed and untreated. Consult your doctor right away if you suspect you’re experiencing depression after a stroke.