Caregivers, Stroke Survivors and Depression
According to the Center for Disease Control and Prevention, each year four million Americans who have survived a stroke are living with impairments, 15% to 30% are permanently disabled, and one third of those patients will suffer from symptoms of depression with few receiving any specific antidepressant therapy or active management. These mood problems can occur at varying times of the course of the stroke victim’s life, most notably in the first year but not exclusively during that time.
As the family therapist I routinely witness the successes and triumphs, but also the effects of stress and burnout on family and friends who serve and care for their loved ones. It is not always easy to keep your chin raised and spirits up while repeating information for the third time, maintaining rigorous schedules of health care appointments and instructions while trying to take care of your own needs and possibly work responsibilities, at the same time. (“What, I have needs too?”)
Cognitive impairment is one of the key effects of stroke impairment. The diminished ability to think or concentrate and increased indecisiveness can also be symptoms of depression. When these symptoms coincide with other physical or emotional changes that don’t go away, such as a depressed mood or irritability experienced most of the day, nearly every day; decreased interest or pleasure in most activities; feelings of worthlessness or guilt that don’t subside, an experienced professional may determine that depression is at work alongside the consequences of stroke.
For caregivers, it is important to realize that you, too are affected by the mood issues of those you spend time with. While we strive to maintain our autonomy and mental / emotional health while taking care of someone else, it isn’t possible to completely detach ourselves from the effects of some else’s ongoing struggles with the physical, psychological, emotional and spiritual changes that a stroke or other medical issues can bring. Keeping the family system in tact is part of what family therapists are trained to do. Meanwhile, having the correct mental health diagnosis by a trained professional may be in order for your loved one. Treatments are available. Doctors and therapists want to be helpful but may need the information that only caregivers can provide, as they observe the behavioral and motivation challenges depression can bring.
You may want to take note of observable changes in your loved one over time, and discuss those concerns with care providers. Keep notes so that if and when it is time to share your observations with a doctor, your information is clear and easily accessible. Therapists and doctors usually appreciate it when patients have a support system and value their input, especially when provided with an attitude of helpfulness and collaboration. If you express concerns about mood or behavioral issues to the doctor, he or she can then assess for those medically related problems with your loved one, and provide solutions if they are warranted. If depression is an issue, treatments are available.
Ask your loved one’s doctor or medical assistant about the best way to approach him or her with your concerns. If you are worried about how your loved one might react, consider expressing this concern to the health care professional in a frank manner, with a “team spirit” attitude. If the situation is especially problematic consult a family therapist about how you might proceed.
Remember, sometimes input from family and friends about a patient’s mood and behavioral changes contain crucial data for health care professionals. The key points to remember are that advocating for your loved one in a helpful and timely fashion can be essential. When in doubt on how to proceed, ask your loved one’s doctor or consult with a family therapist for support.