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Post-Stroke Depression: What You Need to Know

Stroke Statistics

Getting diagnosed and treated with a chronic illness is a major life obstacle that a number of people face. It is life-changing, and most people with stroke associate their diagnosis with a stressful lifestyle that most likely contributed to their first stroke episode.

Stroke happens when the one or more blood vessels supplying blood to the brain gets clogged up. It can be because of either a blood clot blocking the passage of blood, or a buildup of atherosclerotic plaque that narrows blood vessels. As a result, oxygen starvation happens, resulting in brain damage and loss of function (World Stroke Organization, 2021).

Statistics show that over 13 million people will have a stroke each year, and around 5.5 million die because of the condition (World Stroke Organization, 2021). Stroke survivors experience a lifetime dealing with the consequences of a stroke episode, and with the current pandemic, chances of having a stroke episode just continue to soar higher. On the average, someone in the US experiences a stroke episode every 40 seconds, and someone dies of a stroke every 3 minutes and 33 seconds (American Heart Association, 2021).

Stroke and Depression

The aftermath of a stroke episode is not easy. While others are able to regain function, most patients become debilitated for the rest of their life. Stroke does not only burden the patient, but it also burdens the caregivers and the rest of the patient’s loved ones inevitably.

Stroke causes a variety of physical, mental, familial and societal burdens and responsibilities, with post-stroke depressive symptoms as the most common mental sequela.

This commonly occurs three to six months post-stroke, and is considered extremely harmful to the stroke survivor considering that it can delay or even halt recovery. Despite the sad fact that it is most commonly undiagnosed by healthcare providers, post-stroke depression is definitely treatable.

The symptoms of post-stroke depression is just like any case of depression, which includes the following: depressed mood, lack of interest in previously enjoyable activities, changes in eating patterns, changes in sleeping patterns, apathy, restlessness, feeling slowed down, fatigue, feelings of worthlessness, excessive or inappropriate guilt, diminished ability to think or concentrate, indecisiveness, and recurrent thoughts of death.

Major depression should be suspected in a person that has five or more of the abovementioned symptoms in a span of two weeks, and at least one symptom should include depressed mood or lack of interest in previously enjoyable activities. Physicians often overlook depression in post-stroke patients because some fail to assess for stroke symptoms on their patients, or because of the tendency of stroke patients to hide their depressive symptoms. A number of stroke patients may also have difficulty recognizing stroke symptoms in themselves. Failure to see the symptoms will inadvertently lead to less likelihood of seeking treatment for the symptoms as well.

Mood depression is the strongest predictor for the quality of life in stroke survivors. The onset for stroke symptoms can be noted as early as one month after the incident, or even as late as several years post-stroke. With this symptom window in mind, what can a post-stroke patient or a caregiver possibly do?

What to Watch Out

Symptom onset in post-stroke patients vary because of two factors: (1) actual biochemical changes that happen in the brain following a stroke, and (2) changes in mood and personality that take place as time passes. These changes in mood and personality are often consequences of:

  • Lack of social interaction

  • Genetics

  • Brain damage resulting in limitations of physical and mental abilities.

On top of the usual depressive symptoms, patients should also watch out (and be observed for) any of the following mood changes:

  • Irritability

  • Sleep disturbances

  • Behavioral changes including apathy, anxiety and agitation

  • Fatigue

  • Hallucinations

Studies are not able to exactly determine the prevalence of post-stroke depression because some caregivers found it difficult to assess for symptoms. In addition, studies are consistently met with methodological problems related to the recognition, assessment, and diagnosis of depression.

To date, pharmacologic treatment for depression is the mainstay of treatment for these cases, although a lot of physicians are hesitant to prescribe more medications for depression because of the possible drug interactions that antidepressants are typically known for. Psychotherapy remains to be a secondary option because it is more expensive, and results take more time than that of pharmacological therapy. Thus, a keen eye and high index of suspicion remains to be imperative to diagnose post-stroke depression in a patient. It would be highly beneficial that both patient and caregiver alike are educated on what to watch out for, and always surround themselves with people who can offer them a positive outlook on life.

Aside from looking out for the patient, caregivers also need to look after themselves. Needless to say, if you are a caregiver aiding a stroke patient, always be in a lookout for these signs and symptoms:

  • Persistent feelings of sadness and anxiety

  • Lack of interest in previously pleasurable activities

  • Feelings of insignificance and hopelessness

  • Fatigue, irritability, and difficulty in concentration

  • Sleeping disturbances, which can come in the form of sleeping too little or too much

  • Eating disorders, such as loss of appetite or overeating

  • Lack of interest in spending time with family and friends

  • Suicidal thoughts

It is incredibly important to consider both the mental health status of the patient and the caregiver. With the current pandemic, there are several avenues that can help post-stroke patients and caregivers. Telemedicine, online therapy, and wellness coaching can be very instrumental in maintaining a positive outlook and life.

What You Can Do

Going through a chronic illness is already debilitating enough – but do not let it drain away the spark in your life. If you are a caregiver, seeing your loved one suffer from this disease may be a hard pill to swallow – but take heart and be strong for yourself and for your patient. There are a lot of things you can do and to keep both of your heads above water.

  • Be a member of a support group.

Going through the same experience might have different effects on varying individuals, but a common ground helps become the pain bearable. Having someone who can relate to what you are going through eases the loneliness that chronic illnesses bring.

  • Always remember to eat right and healthy.

We have to admit, eating right makes us feel good from the inside out. So go for a diet rich in fruits, vegetables, and lean meat – and say no to fatty and processed food. A good diet results in a healthy and functioning digestive system, and we have to admit, not having bowel movement at the right time can make us cranky and somehow irritable! And do not forget to hydrate, hydrate, hydrate!

  • Socialize.

Going out to meet people might have been a good idea but the pandemic makes the idea far off. Nonetheless, make sure to socialize – albeit virtually or via small gatherings. Just keep safe, keep that mask on and your disinfectants on standby. Just make it a point to be able to talk, catch up with family and friends, and express yourself. The hugs can wait though.

  • Get every inch of your body moving and exercise – everyday.

Physical activity such as dancing lets you give off happy hormones – aside from speeding up recovery and keeping depression at bay. So make it a point to sweat a little each day. You can opt for walking and other low-impact exercises as part of your routine.

  • Visualize recovery with your caregivers.

If you are a post-stroke patient, carefully craft out a plan with your caregivers so you can have some activities to look forward to each day. Visualize independence, for example, with your caregivers. Ask them to help you figure out a task you can do independently and let you do it by yourself. Little by little, depending on your progress, you can then gradually step up the tasks you are able to perform. The important thing is for you not to lose your independence and thereby improve your outlook in life.

It may be difficult to accept and come to terms with the consequences of stroke, but never undermine the power of optimism and mental stability in dealing with it. One of the best pieces of advice is to surround yourself with people who radiate positivity at all times. Post-stroke consequences might be a huge challenge, but it can be overcome.

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