Awareness and Treatment Can Improve Overall Health and Reduce Suffering

Facts on Depression After a Stroke
There are currently about 3,000,000 stroke survivors in the U.S., each year an additional 400,000 – 550,000 people will suffer a stroke. Clinical depression affects about 10 percent of the general population and is significantly more common in stroke survivors, occurring in between 10-27 percent of them. Unfortunately the co-occurring illness is often unrecognized, because treating post-stroke depression can improve patient health in several ways.

The average duration of major depression in stroke patients is just under a year. An additional 15-40 percent of stroke survivors will have some of the symptoms of depression within two months following the stroke.

Early diagnosis and treatment of co-occurring depression are important because this second illness adds to a patient’s suffering, interferes with rehabilitation and family relationships, and reduces quality of life.

Treating Depression Has Many Benefits
Studies show that post-stroke patients who are depressed, particularly those with major depression, are less compliant with treatment, are more irritable and demanding (making care and rehabilitation more difficult), and may experience personality changes that disrupt family relationships. Research also shows that treating depression can shorten rehabilitation time, leading to more rapid recovery and resumption of routine. Treatment may also reduce health costs, for example, by shortening or avoiding nursing home stays.

Depression is Often Undiagnosed and Untreated
Depression in stroke survivors goes unrecognized for several reasons. If symptoms are not assessed for their severity and duration, they may be dismissed as the temporary low mood that is a common reaction to stroke. Or some of the depressive symptoms may be attributed to injury from the “brain attack”, which can also impair memory, concentration, and attention. Finally, because three-fourths of strokes occur in people aged 65 and older, depression may be mistakenly viewed as a normal part of aging. Careful evaluation can overcome these diagnostic hurdles and if depressive illness is present it should be treated.

Risk Factors
Factors that contribute to depression following a stroke are: the location of the brain lesion, previous or family history of depression, and having had difficulties with social functioning prior to the stroke.

Effective Treatment for Depression
With treatment, up to 80% of depressed people can improve, usually within weeks. Treatment includes medications, psychotherapy, or a combination of both. The severity of the depression, the other conditions present, and the medical treatments being used must be considered to determine the appropriate treatment.

Antidepressant Medications
Several types of antidepressant medications are effective, none of them habit-forming. Most side effects can be eliminated or minimized by adjustment in dosage or type of medication, so it is important for patients to discuss all effects with the doctor. Also, because responses differ, several trials of medicine may be needed before an effective treatment is found. In severe depression, medication is usually required and is often enhanced by psychotherapy.

Psychotherapy
Cognitive/Behavioral Therapy and Interpersonal Therapy have also been shown to be effective in treating depression. These short term (10-20 weeks) treatments involve talking with a therapist to recognize and change behaviors, thoughts, or relationships that cause or maintain depression and to develop more healthful and rewarding habits.

The Path to Healing
Depression can be overcome through recognition of symptoms, and evaluation and treatment by a qualified professional. Stroke survivors, their loved ones, and their physicians should be alert for the symptoms of depression and seek an evaluation when indicated.

If depression is diagnosed, family and friends can help further by encouraging the depressed person to remain in treatment. Participating in a support group may be a helpful addition to treatment.

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