Healthcare professionals have long been aware of the link between stroke and depression. After all, a stroke affects both the mind and the body and is a life-changing event.
In this article, Stroke Rehab Times looks at the impacts of stroke on survivors’ emotional and mental wellbeing.
How common is depression after stroke?
Very. Around one in three people experience depression at some point during the five years after their stroke.
Having a stroke can change the way survivors feel about themselves and their future.
The impact of a stroke on the brain can also cause personality, mood and emotional changes, as well as certain physical limitations, which can lead to, or increase, depression and anxiety symptoms.
Worryingly, it can become a vicious circle and there is evidence to suggest that suffering from depression may hamper recovery from a stroke.
In a 2015 evidence review published in The American Journal of Psychiatry (AJP), patients with post-stroke depression (PSD) who responded to treatment with anti-depressants were found to have better improvement in daily living activities than patients who did not respond to active treatment or placebo.
Another study cited in the review found that treatment of PSD with nortriptyline or fluoxetine over 12 weeks led to improved cognitive function to the level seen in non-depressed stroke patients.
The issue is not confined to stroke patients themselves.
A report by the National Institute for Health and Care Excellence (NICE) found that 30 per cent of patients will suffer from depression at some point during their recovery from stroke, with many remaining undiagnosed or inadequately treated.
The authors wrote: “Psychological mood disturbance is associated with higher rates of mortality, long-term disability; hospital readmission; suicide and higher utilisation of outpatient services if untreated.”
NICE also noted that those who care for people with stroke often experience significant psychological problems themselves.
What causes it?
Depression after stroke can be caused by a number of factors and is also thought to be more likely for those with the following risk factors:
- Previous mental illness
- Female
- Previous condition that affected how you think, such as a traumatic brain injury
- Previous functional difficulties, such as those caused by Parkinson’s disease or other neuromuscular disorders
- Live alone
Strokes that leave the survivor with a high degree of physical disability and neurological problems also raise the risk of depression. For example, patients who develop aphasia, which affects the ability to talk and understand words, are more likely to become depressed.
However, depression after stroke may also have a more neurological basis, caused by biochemical changes in the brain during the event itself.
As the authors in the AJP research note: “The most consistent finding in the stroke literature is that PSD is associated with stroke severity and the degree of functional physical and cognitive impairment.
“However, it is uncertain whether the level of impairment is etiologically associated with the development of PSD through a “reactive” psychological mechanism or whether there are biological factors related to brain damage that contribute to the bidirectional relationship between disability and depression.”
How is depression after stroke treated?
Like any form of depression, PSD can be dealt with in one of three ways – or, more likely, a combination of them all.
First of all is some form of talking therapy, such as cognitive behavioural therapy (CBT). This can help survivors process some of the emotions they may experience after a stroke, by focusing on thinking and behaviour and how they are connected.
CBT can help break the cycle of negative thoughts that stroke survivors may be dealing with, improving the way they feel.
Therapy can be offered alone or alongside medication where necessary.
Common medications used to treat depression include:
- Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine and paroxetine
- Serotonin-norepinephrine reuptake inhibitors (SNRIs), such as duloxetine and venlafaxine
- Tricyclic antidepressants, such as imipramine and nortriptyline
- Monoamine oxidase inhibitors, such as tranylcypromine and phenelzine
Treatment depends on the patient’s level of depression and how long it has lasted.
Other methods of avoiding and alleviating depression after stroke include general wellbeing guidance, such as making sure to eat a healthy diet full of fruits, vegetables and lean meats, and taking regular exercise, which can also help speed up stroke recovery.
Other stroke-specific measures include avoiding social isolation or joining a support group.
Patients who are struggling with the loss of independence after a stroke are encouraged to work with their family, carers and medical professionals to try to find tasks they can do themselves, to regain their sense of autonomy.
