Depression.
According to several sources (e.g. American Heart Association, National Institute of Mental Health, etc.), depression is one of the major problems associated with stroke. Whether a cause or a result of the stroke, depression takes its toll on the patient and the caregivers. Both have had to deal with life-changing events and both now have to cope. The more severe the stroke, the more the caregiver burden and in turn the increased risk of depression. And for the patient, anxiety and depression can go hand in hand to cause the stroke and even increase risk of a recurrent stroke. Please pay special attention to this page as it can save a life.
What Does Depression Look Like?
As approximately 33% of those who have survived stroke develop depression and 25% develop anxiety disorders, it is critical to recognize the signs and symptoms associated. The following are typical signs and symptoms that persist over extended periods of time:
Depression is not only a mood disorder, there are changes that occur with neurotransmitters in the brain. With the damage to the brain, the brain receives inflammatory markers such as cytokines and cortisol. As GABA levels rise in response to the brain injury, serotonin and dopamine (the "happy" hormones) levels fall. Other physiological effects of depression and anxiety can include high blood pressure, which therefore increases risk of a second stroke.
As approximately 33% of those who have survived stroke develop depression and 25% develop anxiety disorders, it is critical to recognize the signs and symptoms associated. The following are typical signs and symptoms that persist over extended periods of time:
- Sadness, anxiousness, emptiness
- Hopelessness
- Guiltiness, worthlessness, helplessness
- Irritability and restlessness
- Lack of interest in things you used to love
- Chronic fatigue or malaise
- Difficulty with concentration, memory, or decision-making,
- Poor sleeping habits and a change in diet
- Chronic pains that do not relieve with interventions
- Thoughts of death or suicide
Depression is not only a mood disorder, there are changes that occur with neurotransmitters in the brain. With the damage to the brain, the brain receives inflammatory markers such as cytokines and cortisol. As GABA levels rise in response to the brain injury, serotonin and dopamine (the "happy" hormones) levels fall. Other physiological effects of depression and anxiety can include high blood pressure, which therefore increases risk of a second stroke.
Who Gets Depression?
Depression is a huge risk for patients post stroke, but also their caregivers. Therefore, it is important to ensure the healthy mental states of both the patient and the caregiver. Associated with depression after stroke are: poor quality of life, poor rehabilitation outcomes, lengthier hospital stays, and reduced cognition. Patient. Risk factors for patients include: disability after stroke, history of anxiety and depression, poor family or social support, and reduced cognition. Following stroke, the patient experiences changes with their body that may render them in need of assistance. A patient who previously lived alone and was able to care for themselves may find that now they are living with family members and need help simply getting up from their chair to use the bathroom or even sitting up in bed to be fed. Strokes range in severity and disability, so not every survivor will need significant assistance. However, feelings of dependence and social isolation can develop into depression. The Journal of Rehabilitative Medicine has split social support following stroke into 3 categories that evolve over the years following the event: everyday support, esteem support, and support in problem situations. Oddly enough, the type of support associated with increased risk of depression is support in problem situations - the patient feels as though they still do not have full independence. However, on the other hand, the journal reports that everyday support and esteem support can result in depression due to the social isolation of requiring significant caregiver assistance. Caregiver. Unfortunately, depression in caregivers is nearly as common as depression in patients with stroke. Caregiver burden has been researched but poorly understood due to its highly variable nature. Though caregiver burden has been researched in general, it has been suggested that subcategories of burden should be assessed. Risk factors for depression in caregivers include: the amount of support they must provide and disabilities of the caregivers themselves. Knowing that there is a support system for themselves and resources for assistance is critical to reducing the burden of care in the caregivers. |
How Is Depression Treated?
The first step to treating depression is being able to recognize it. Recognizing the signs and symptoms is a very simple means of identifying a problem, but furthermore being able to screen for depression is helpful because the screening tools are validated methods. For instance, the MoCA (Montreal Cognitive Assessment), DISCs (Depression Intensity Scale Circles), HDS (Hamilton Depression Scale), and HADS (Hospital Anxiety and Depression Scale) are some validated measures that can identify and measure changes in depression. *Please notice the links to the tests for reference. Once your physician has identified the presence of depression, it is time to discuss treatment options. 1) Cognitive Behavioral Therapy is the least invasive intervention that involves psychological retraining via discussions with a professional. This method focuses on turning negative thoughts into positive thoughts. 2) Medications such as SSRIs (Selective Serotonin Reuptake Inhibitors like Zoloft) or SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors like Cymbalta). Both classes of drugs operate by keeping the "happy" hormones like serotonin, norepinephrine, and dopamine in the brain rather than being reabsorbed. 3) Finally, a new FDA approved method of treatment is transcranial magnetic stimulation. In this case, magnetic fields are set up to activate nerve cells in the regions of the brain that deal with emotions and moods. Other resources for help include strokecenter.org and "Life After Stroke" at American Heart Association for both the patient and their caregivers. Involvement in support groups, lifestyle changes, as well as being educated on stroke will significantly improve recovery post-stroke. |