Stroke and Depression

How to Deal With Depression After a Stroke

A stroke can trigger depression

For most people, the word "stroke" brings to mind a constellation of problems, including paralysis and difficulty with speech. But if someone has recently had a stroke, you're probably well aware that the effects go well beyond the physical. The emotional aftermath can be just as overwhelming and far more difficult to sort out.

Although depression can strike anyone, those who've suffered a catastrophic illness may be more susceptible than other people. And when you throw a brain injury into the mix, the risk of developing a mood disorder becomes even greater. As many as half of stroke survivors will become depressed, according to James Castle, a neurologist at Stanford University.

Depression isn't just miserable, it may also make a stoke survivor more susceptible to pain and fatigue and may even delay his recovery.

  • In a study published in the journal Stroke, researchers reported that stroke survivors who were treated for depression demonstrated improved recovery in regular daily activities compared with those whose depression went untreated.
  • People who are depressed also tend to be less compliant with rehabilitation and more resistant to making lifestyle changes to prevent a second stroke.

Fortunately, depression can be treated. With the appropriate care, a patient will lead a happier life -- and life will be easier for you, too. Here are some practical things you can do if you think the person you're caring for is depressed after a stroke.

Be alert to warning signs of depression after a stroke

It's not always easy to recognize depression. In the case of someone who's had a stroke, the situation can be even more complicated. If a patient has trouble talking or understanding language, it might be especially difficult to recognize depression. Increased emotional liability -- sudden and extreme mood swings, common after a stroke -- may also hide symptoms of depression.

You may also think he has good reason to feel depressed. After all, he's just had a stroke and can't do the things he used to be able to do. But there's a difference between the normal grieving process and depression. The warning signs of depression include:

  • Frequent crying episodes
  • Feelings of hopelessness or worthlessness
  • Poor appetite or increased appetite
  • Sleeping too much or not enough
  • Increased agitation and restlessness
  • Loss of interest in life
  • Expressing thoughts of dying or suicide

A stroke survivor should be evaluated for depression if he has had several of these symptoms for more than two weeks.

Encourage a stroke survivor to be tested for depression

If you believe a patient is depressed, the first step is to talk to him about his feelings. This isn't always easy, especially if he isn't used to expressing emotions. Ask him if he's feeling sad or hopeless. Try to get an idea if it's really depression or just a temporary case of the blues.

The next step is to schedule an evaluation. His primary care physician may want to talk to him first, or she may refer him to a psychiatrist or counselor. In any case, the evaluating doctor will talk to him and assess his mood. She may also order screening tests to rule out other medical conditions that can mimic depression, such as a thyroid disorder or infection.

If he resists the idea of testing because he's embarrassed or afraid, help him understand that a diagnosis of depression isn't the shameful secret it once may have been. It doesn't mean he's "crazy" or is going to be taken away to a nursing home . And his test results are private, so no one b ut he and his doctor needs to know.

If he absolutely refuses to see a doctor, there's not a whole lot you can do. "There's no way to force the issue unless there are severe circumstances," says Castle. If he has become psychotic or suicidal, or if his depression has progressed to the point where he can no longer care for himself, Castle recommends that you notify his doctor or emergency medical services immediately. Otherwise, your best bet is to enlist family members and friends to try to persuade him to seek help.

Support a stroke survivor during treatment for depression

If a patient is diagnosed with depression, the doctor may prescribe antidepressant medications and/or recommend psychotherapy. "Most doctors take a multidirected approach toward battling depression," says Castle. "Medicines can be highly effective, but often there's a role for psychotherapy and lifestyle changes."

Even if a primary care doctor diagnosed depression, a patient may still benefit from seeing a mental health professional, says Castle. "Some primary care physicians feel comfortable treating this disorder, but many would prefer the assistance of a psychiatrist or psychologist." Castle says this can be difficult for people who associate a stigma with mental health treatment. "It's important for the family to support the patient over that barrier."

The perso n in your care may also be nervous about taking antidepressants, but Castle points out that they present very little risk: "If anything, there's some evidence to suggest that these medicines might actually decrease the chance of having another stroke." Some of the common side effects, such as loss of libido or excessive sweating, can be annoying, but they're nothing compared to the misery of depression. And the doctor can work with the patient to find the most effective medication with the fewest side effects.

Other ways you can help a stroke survivor with depression

Simply supporting the patient as he struggles with depression can help him a great deal. Here are some other things you can do:

  • Help him stay as physically active as possible. Talk to the doctor and rehabilitation team about what exercises are appropriate. Find activities you can do together, such as a morning walk around the neighborhood.
  • Depressed people often want to sleep during the day. "As much as possible, don't allow a patient to slip into a depressed routine," says Castle. "Break the cycle by encouraging him to be awake during the day with exposure to sunlight." A simple walk outdoors or some time in the garden can really help.
  • Structure the day around activities that give him pleasure and a sense of purpose. For example, meet friends for lunch or enjoy a leisurely walk through the mall.
  • Try to stay positive and upbeat, but don't foster unrealistic expectations. Instead of saying, "You'll be hiking again in no time," you might say, "If we keep walking together every day, you'll notice that it gets a lot easier."
  • Join a support group -- for either or both of you. Talking to other people who're struggling with similar issues can be enormously comforting and helpful. It's also a great way to connect with other stroke survivors and caregivers . Remember that it's not all up to you

In the end, it's really up to the stroke survivor to get help for depression. If he won't talk to his doctor or comply with treatment, you can't make him -- and you shouldn't blame yourself. Keep offering support and provide positive reinforcement when he takes those difficult steps toward recovery.

But there's only so much you can do. If feelings of guilt and sadness overwhelm you, you may need help coming to terms with the fact that he isn't going to get help. Ask his doctor for information about support groups and other resources to help you manage your own feelings.

Source: E. Chemerinski et al. "Improved recovery in activities of daily living associated with remission of post stroke depression." Stroke 32, 2001.