Stroke and Depression

DSM-V Definition:

  • Lasting 2 weeks or more
    • Depressed mood (sad, tearful)
    • Loss of interest or pleasure
  • Any four of the following:
    • Weight loss
    • Changes in sleep patterns
    • Slowed movements/restlessness
    • Fatigue/loss of energy
    • Feelings of worthlessness or guilt
    • Diminished ability to think or concentrate
    • Recurrent thoughts of death or suicidality

These symptoms are not attributable to medication, drugs/alcohol, or other medical condition, and cause distress/impairment in social, occupational, or other important areas of functioning.

How is Depression Different from Grief?

Depression is prolonged, interferes with a person’s ability to function normally, gets worse over time, and is disproportionate to the event(s).  People with depression may also experience suicidal thoughts.

Grief is usually swift (up to one year), and does not interfere with a person’s ability to carry out daily tasks.  Grief gets better over time.

Broad Causes of Depression

  • Internal Factors (genes, personality)
  • External Factors (alcohol, social environment, medical illnesses)
  • Adversity (trauma, childhood loss)

Treatment Options

  • Recognition (diagnosis)
  • Destigmatization
  • Treatment plan (antidepressant medications, psychotherapy, care management, exercise/diet/sleep, etc)
  • Maintenance

Medications

Please discuss any and all depression medications with your doctor to find the one that works best for you!

All medications may have side effects (gastrointestinal effects, sexual dysfunction, lethargy/sleepiness, weight gain, etc). 

Psychotherapy

  • Cognitive-Behavioral Therapy (identify distorted beliefs and exercises to reduce symptoms)
  • Interpersonal Psychotherapy (focus on interpersonal difficulties like grief, roles, disputes, etc.)
  • Family & Couples Therapy (focus on relationship, family problems)
  • Psychodynamic Psychotherapy (focus on developing insight into how past experiences/conflict affect us)
  • Supportive Psychotherapy (focus on encouragement, empathy, services available to help)

Other Supportive Care

  • Treatment of insomnia / screen for sleep apnea
  • Exercise
  • Behavioral Activation (get out and do things)

Post-Stroke Depression

  • Frequently feeling sad, down, depressed, or not interested in life
  • Results in problems doing things that should be done
  • Occurs sometime after a stroke

Depression After Stroke is Common

  • Of over 20,000 patients, 29% said they suffered from depression. 
  • It can occur anytime after a stroke
    • 36% at hospital discharge
    • 48% at 3 weeks after a stroke
    • 39% at 1 month after a stroke
    • 52% at 3 months after a stroke
    • 25% in the first 2 years

Risk Factors

  • Severe strokes, or those that leave a patient physically or mentally impaired
  • A prior history of depression or anxiety
  • Older age
  • Women
  • People with less education
  • Diabetes or other chronic illnesses
  • Stroke location might not matter…

Resources

www.stroke.org

Stroke Foundation.org

Depression May Boost Seniors’ Risk for Heart Disease, Stroke