When a person has a stroke, blood supply is interrupted and lost to an area of the brain. This can lead to a range of challenges that can persist well after the initial crisis has passed. While some of the symptoms can be more readily apparent to the outside observer (i.e. slurred speech, weakness or walking difficulties), others are often invisible (i.e. depression, anxiety or cognitive problems), and can lead to great deal of distress. The invisible symptoms can be even more distressing because they’re often not well understood nor easy to explain, and they can have an enormous impact on recovery and quality of life.
Depressive symptoms, often referred to as post-stroke depression, are a common issue that arise in the aftermath of the stroke. Approximately one-third of all stroke survivors will at some point experience significant depressive symptoms that interfere with functioning. In comparison, it’s estimated that between 5% and 13% of adults without stroke experience significant depressive symptoms.
There are factors that put a person in a higher risk category when it comes to developing symptoms of post-stroke depression. These include:
1. Physical disability.
2. Severity of stroke.
3. Preexisting depressive symptoms.
4. Severity of cognitive impairment
What should a person look for when trying to identify post-stroke depression in themselves or a loved one? While it may be particularly difficult to assess because of the overlap with what might be directly related to the stroke, it’s important to look at and listen for the following:
— Depressed mood.
— Loss of energy or increased fatigue.
— Loss of interest in things that were once found enjoyable.
— Increases or decreases in motor functioning.
— Changes in appetite.
— Changes in sleep.
— Difficulties with concentration.
— Increased irritability or agitation.
— Suicidal thoughts/actions. (Call the 24-hour suicide/crisis Hotline 1-800-273-TALK, or go to the emergency room.)
While symptoms of depression are largely the same no matter how or when the depression develops, it’s important to remember that when they develop in a person who has suffered a stroke, they can come on quite abruptly and out of nowhere. This may make it more difficult for a person to recognize that they are experiencing depressive symptoms, to acknowledge the need for help in this area and to accept help. Being patient and appreciating the novelty of these depressive symptoms in addition to any other symptoms from stroke can be helpful for caretakers and loved ones.
There are three more formalized avenues for treating post-stroke depressive symptoms. Initializing treatment can be a difficult first step and is most successful when introduced as a regular component to post-stroke recovery by the patient’s medical team. The three formal/professional treatment options are:
1. Psychotherapy. There are many forms/approaches to psychotherapy. Psychotherapy is also known as talk therapy and is performed by a licensed psychologist or licensed therapist, such as social workers or professional counselors. Cognitive behavioral therapy is one of the most commonly utilized and effective forms of therapy for people recovering from stroke.
2. Medications. These can include those that many are familiar with, like paroxetine (brand name Paxil), fluoxetine (brand name Prozac) and sertraline (brand name Zoloft). Consultation with a medical provider is necessary for prescribing medications, and the provider treating the stroke should always be integrated into this decision-making process to ensure the medication is a safe choice. Often, a psychiatrist (a medical doctor) is consulted to offer higher level of expertise in prescribing these types of medications.
3. Combination. Utilizing medications in conjunction with psychotherapy is often the preferred approach to treating depressive symptoms that don’t seem to respond to medication or psychotherapy alone. This approach is very effective for establishing consistency in treatment.
We know that other factors are protective against stroke and can lead to significant improvements in depressive symptoms post stroke. These factors are considered part of a generally healthy lifestyle and include:
— Getting regular daily exercise (work with your health care team to find what’s safe and healthy).
— Following a Mediterranean diet that includes lean meats, green leafy vegetables and fruits.
— Regularly socializing with friends and family.
— Attending a support group for stroke survivors.
— Incorporating 20 to 30 minutes of relaxation training daily (i.e. diaphragmatic/deep breathing or meditation).
The changes in day-to-day functioning following a stroke can feel overwhelming and lead to increases in depressive symptoms. In addition, unlike any other time in our history, we have even more significant challenges as a result of the COVID-19 pandemic. Stroke survivors are faced with the uncertainty of risking possible exposure to the virus in order to attend an appointment or support group, socialize or go to the gym.
In addition, the mere knowledge that stroke survivors are in a higher risk category as it relates to COVID exposure can deepen symptoms of depression and feelings of hopelessness. The current societal restrictions and limitations associated with the pandemic severely inhibit many of the health coping mechanisms that may have been utilized to combat episodes of depression. It’s also more difficult to access a social network, exercise program or support group. There certainly are creative ways to access important health-promoting activities during the pandemic, in particular the use of virtual platforms. Still, this may be difficult for some survivors of stroke and/or those not well-versed in the world of digital communication.
Finally, know that post-stroke depression is common and treatable. Please consider reaching out to professionals for guidance and help.
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