How to Recognize Serious Depression After a Stroke

Did you know approximately 800,000 people suffer a stroke each year? There is a bit of good news — death rates from stroke are declining, and many people are living much longer after a stroke. Unfortunately, many of those survivors then suffer major depression after their stroke.

“Stroke survivors experience feelings of anger, frustration, anxiety, sadness, fear and hopelessness. These emotions are common with post-stroke depression, which affects more than one-third of stroke survivors,” says Dr. Ashish Masih, a neurologist at INTEGRIS.

Sadness can be a natural response after stroke, since many stroke survivors go through a process of grieving and isolation as they adjust to life with a “new normal.” They may mourn their loss of mobility, their ability to communicate and especially, their independence.

But if the depression becomes serious enough, it can greatly decrease a patient’s quality of life. Depression will affect a survivor’s daily functioning, interfere with recovery and even decrease his or her lifespan. Here are other major side effects that can happen if the depression is left untreated.

• Increase the disability from stroke
• Decrease a survivor’s mental abilities
• Increase the risk of falls
• Make physical rehabilitation more difficult

What causes depression after stroke?

According to Dr. Masih, “A stroke can cause structural and chemical changes to the brain. If the frontal lobe is affected, personality changes can result.”

In addition, there are certain risk factors after a stroke that are particularly strong triggers of depression. These risk factors include:

• Losing the ability to walk
• Losing the ability to move
• Loss of bladder or bowel control
• Problems communicating
• Thinking or memory problems
• Previous history of depression
• Previous history of alcohol or drug abuse
• Lack of family or social support

Signs of depression after stroke

An actual diagnosis of post-stroke depression can be difficult to make because of the physical and mental impairments patients may suffer from the stroke itself. Also, some symptoms can be caused by both a stroke and depression, such as a change in appetite or sleeping patterns.

In general, the signs of post-stroke depression are similar to the signs of depression in the broader population. These signs can vary, and not all signs will be present for every patient, according to the National Stroke Association, but here is a list of symptoms that could indicate a survivor is clinically depressed.

• Feelings of sadness, loss, despair or hopelessness that don’t improve over time
• Lack of interest or pleasure in usual activities that lasts more than two weeks
• Self-criticism, with feelings of guilt, worthlessness, or feeling like a failure
• Changes in sleeping patterns
• Changes in appetite
• Inability to concentrate
• Withdrawal from loved ones
• Thinking or talking about suicide

Treatment for post-stroke depression

It's very important for survivors to remember that their depressed feelings are an expected part of their recovery, and are not a sign of weakness. It’s also important to get professional help as soon as possible. Patients and their families should work with psychiatrists or family doctors to identify what approach is best when it comes to treating post-stroke depression.

For some, antidepressant medicines may help, although it may take a few weeks to feel much better. “I definitely recommend a discussion about antidepressant medication with a patient’s doctor,” says Dr. Masih.

Patients can also benefit from different forms of therapy. Counseling and talk therapy can be very helpful with painful and self-defeating thoughts.

Other recommendations for stroke survivors

• Be as physically active as possible each day.
• Schedule daily routine activities for structure and purpose.
• Set goals and find ways to measure accomplishments — even small ones count.
• Get out and enjoy regular social activity, which can help stimulate and improve language recovery.

Another treatment option is to attend stroke support group meetings, where survivors and family members share practical experience and lessons learned. The National Stroke Association coordinates meetings in Norman, Oklahoma City, Tulsa, Enid and Duncan.

INTEGRIS also provides a list of stroke support group meetings for both survivors and caregivers and also provides other resources to help with life after stroke. 

Mary Pinzon, RN, CPE, M.Ed, is a stroke education nurse at INTEGRIS. For more information about living life after a stroke, or to schedule a presentation, please call Mary at 405-644-6867.