Depression After Stroke

Nearly two-thirds of people who experience a stroke also find themselves battling depression. It can be attributed to a variety of causes, including the emotions due to physical losses or simply the overwhelming reality of going through the therapy needed to recover. Depression after a stroke can also stem from biochemical changes in the brain. A brain injury can interfere with a person’s previously normal emotional state.

Caregivers will expect a loved one to be sad after a stroke. It’s important they know the symptoms of depression and those of apathy, the feeling of indifference or not having emotions at all. An apathetic person is satisfied and content doing nothing, and isn’t bothered by it. This is often seen in those who have had right-brain strokes.

Depression, however, is marked by feelings of sadness or discouragement and even suicidal thoughts. The symptoms of depression following a stroke are the same as from any other cause. If extreme sadness and hopelessness persist for longer than two weeks, or the person has no interest in therapy, socializing or struggles to concentrate, a caregiver should start to consider seeking help. Depression doesn’t appear at a set time; it can show up weeks or months after the stroke occurred.

Depression doesn’t just affect the loved one either. Family caregivers in general already face a high risk of developing depression. Those who are caring for people recovering from stroke are not only dealing with challenges in mobility, care and communication, but a loved one’s depression adds an additional burden that can lead to the caregiver developing a depression of their own. Research from the American Stroke Association reveals that 30 to 33 percent of caregivers were depressed at their loved one’s 18-month post-stroke checkup appointments.

A study published in the 2011 journal Neurology showed that successfully treating depression in both caregiver and loved one also helps the person’s recovery from stroke. The same study, funded by the National Institute of Neurological Disorders and Stroke, gave industry leaders proof that the correlation between stroke and depression is real, and depression can cause an even greater impact on quality of life than physical/mental impairments from the stroke itself.

Treatment Options

The National Institute of Health says most people dealing with depression following a stroke do not get the help they need. Treatment can be fairly straightforward if the symptoms are recognized and managed early on.

Occupational therapists are trained to notice signs of depression and if a loved one is in therapy, this person can be a first line of defense for treatment of post-stroke concerns. Cognitive behavioral therapy is also beneficial, helping change negative thinking and behaviors that add to their depression. Counseling, group or individual, is another alternative for talk therapy. Many times this helps loved ones work through feelings of loss from the stroke, as well as gain a positive outlook on the future—their “new” normal.

Another common treatment approach is through nutrition. A diet rich in Omega-3 fatty acids, folic acid, Vitamin B and complex carbohydrates is known to help those dealing with depression. Omega-3 fatty acids can be found in foods such as fish, flaxseed and walnuts, and promote a healthy brain. Complex carbohydrates include items like brown rice, oatmeal and whole wheat. They boost the neurotransmitter chemicals in the brain which affect mood. Dark chocolate helps reduce fatigue and stress in a person with depression. Caregivers can think of beans, oranges and broccoli as sources of folic acid, a vital nutrient that helps with cognition. For Vitamin B, eggs, milk and liver increase a person’s energy and alertness.

As with most physical ailments, exercise also helps improve a person’s mental state. Adaptive equipment is available for those who are recovering from a stroke. Walking, yoga and swimming are low-impact exercises which are ideal therapies for post-stroke conditions.

Treatment for post-stroke depression isn’t a one-size-fits-all solution. Treatment is available and a caregiver plays a big part in its success. Anti-depressants often help a loved one get through a tough transition time after a stroke. They are common treatments prescribed by a physician or psychiatrist. Anti-depressants improve mood by interacting with neurotransmitter chemicals in the brain, and there are a variety of options available which a physician can prescribe to see which works the best for that person.

Social Support

While therapy and medication are well-known and successful treatment measures for depression, the importance of social support following a stroke cannot be underestimated.

Treatment alone is not always enough, and if left untreated, depression can worsen other common post-stroke symptoms like malnutrition, incontinence, pain, fatigue and sleep issues. Then, if a person is inhibited in recovery because of depression, those feelings only compound because of the lack of progress toward recovery.

Communication is critical. Relationships can change after a stroke, and that alone is enough reason to keep talking to family and friends. The assurance that while things may be different, the mutual love and respect are still there is so important for a loved one’s recovery from the stroke and depression associated with it. Stroke support groups are often a great benefit and can be found at most local hospitals or stroke centers.

The successful management of depression following a stroke prevents both caregiver and loved one from suffering a great cost. Depression takes a physical and emotional toll, and should never be ignored or minimized. Help is definitely available.

Watching for Depression

The symptoms of depression following a stroke are the same as from any other cause. Caregivers should be alert for the following behaviors in a loved one:

  • Persistent sad, anxious or empty feelings
  • Sleep disturbances
  • Increase or decrease in appetite and eating patterns
  • Feelings of helplessness, hopelessness and/or worthlessness
  • Social withdrawal
  • Loss of interest in activities or hobbies
  • Irritability
  • Fatigue
  • Difficulty concentrating or remembering details
  • Aches, pains, headaches and digestive problems that do not ease with treatment
  • Suicidal thoughts