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Stroke Smart Magazine

Spring 2010

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Depression a Common Problem after Stroke
Consult with Your Health Care Professional for Treatment Options

By Linda Ovitt and Vani Rao

Depression is a common problem after stroke. Major depression, also known as clinical depression, occurs in between 25 percent and 30 percent of stroke survivors. About 20 percent of stroke survivors develop minor depression. If symptoms last two weeks or more and hinder the stroke survivor’s day-to-day functions, it is important to get help. Depression symptoms can be treated under the advisement of your health care provider.

Symptoms of major depression include:

  • Continued sadness.
  • Lower interest or enjoyment in usual activities.
  • Lower energy.
  • Difficulty concentrating.
  • Lower appetite with weight loss.
  • Sleep difficulties.
  • Low self-worth or guilt.
  • Hopelessness about the future.
  • Thoughts of death or suicide.

Symptoms of minor depression are the same as major depression but less severe and with fewer symptoms. Still, it should be taken seriously and treated by professionals.

Caregivers are often the first to notice the decline in mood and overall functioning. It is important that they encourage the patient to get immediate professional help. Treatment of post-stroke depression not only results in mood improvement, but can also enhance cognitive, physical and functional recovery.

Improper diagnosis and/or absence of treatment can:

  • Hinder rehabilitation and slow the post-stroke recovery process.
  • Reduce the survivor’s quality of life.
  • Worsen cognition.
  • Increase dependency with personal activities of daily living.
  • Increase mortality.

The cause of post-stroke depression can be both biological (injury to certain areas in the brain) and psychological (poor support, physical obstacles, financial or job loss).

Treatment should come from different but coordinated disciplines. Rehab therapists, such as physical, occupational and speech/language therapists should watch patients for symptoms. Psychiatrists need to stress the importance of exercise, good nutrition, taking medicine correctly and regular follow-up visits with doctors and therapists.

Antidepressants often are used for the treatment of post-stroke depression. The treating doctor, such as a psychiatrist, will determine the type of antidepressant for the patient, considering its side effects and its interaction with the other medications the patient might be taking. Regular follow up with the doctor is essential and medicines should always be taken as prescribed.

Stroke survivors can also benefit from psychotherapy provided by professional counselors. This offers support, education and hope. A range of techniques are available and can help change the depressed person’s negative thinking, improve communication skills, boost confidence and change abnormal behavior.

Caregivers and family need to be in regular contact with the treatment team and educate themselves about stroke and its consequences. Caregivers can also initiate other interventions, such as activities that lift the patients’ sense of well-being, give them purpose and allow them to assume roles. Be sure to contact your health care professional to ensure the activity is safe for the stroke survivor.

Post-stroke depression is a common but treatable condition. Early diagnosis and treatment can enhance recovery and improve quality of life.

Linda Ovitt is a Senior Nurse Therapist at the Geriatric Psychiatry Neuropsychiatry Clinic, Community Psychiatry Program, at Johns Hopkins Bayview Medical Center, Baltimore; Vani Rao is Section Director in the Bayview Geriatric Psychiatry Neuropsychiatry Program, Department of Psychiatry, at Johns Hopkins University and School of Medicine.


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National Stroke Association’s mission is to reduce the incidence and impact of stroke by developing compelling education and programs focused on prevention, treatment, rehabilitation and support for all impacted by stroke.

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