Depression After A Stroke: Strategies For Recovery And Coping

Depression is a common experience for stroke survivors. It can be caused by biochemical changes in the brain, and when the brain is injured, you may not be able to feel positive emotions.

Post-stroke depression (PSD) is a major driver for poor recovery, negative quality of life, poor rehabilitation outcomes, and poor functional ability.

The Secondary Prevention of Small Subcortical Strokes (SPS3) trial revealed that 19% of stroke patients suffered from PSD, while a meta-analysis of 51 observational studies estimates that one out of every three stroke survivors suffer from PSD.

PSD is associated with higher mortality and poor functional outcomes.

Depression is more common after a major stroke than after a mild one, and is also more likely in people who have already suffered from depression.

The severity of a person's depression often depends on how physically or mentally limited they are in daily life. Studies have shown that a person's social environment and living arrangements can also influence the likelihood of developing depression.

Good treatment and social support can also help reduce the risk of depression developing following a stroke.

PSD can be treated with medication (antidepressants) and/or psychotherapy.

Recognise the signs of depression, such as persistent sad, anxious or empty mood, restlessness and irritability, feelings of hopelessness, pessimism, guilt, worthlessness or helplessness, and loss of interest or pleasure in hobbies and activities

Recognising the signs of depression is crucial to getting the right treatment and support. Depression after a stroke is common, affecting around one-third of stroke survivors. It is often caused by biochemical changes in the brain, and can be accompanied by anxiety. The following are some signs to look out for:

• Persistent feelings of sadness, anxiety, or emptiness
• Restlessness and irritability
• Feelings of hopelessness, pessimism, guilt, worthlessness, or helplessness
• Loss of interest or pleasure in hobbies, activities, and sex
• Decreased energy and fatigue
• Difficulty concentrating, remembering, or making decisions
• Changes in sleep patterns, such as insomnia, early morning awakening, or oversleeping
• Changes in appetite or weight
• Thoughts of death or suicide, or suicide attempts

These symptoms can vary in severity and frequency, and may be accompanied by physical symptoms such as headaches, digestive problems, or aches and pains. It is important to seek professional help if these symptoms persist for more than two weeks and interfere with daily life. Treatment for post-stroke depression often involves a combination of medication (such as antidepressants) and psychotherapy or cognitive behavioural therapy. Social support from family, friends, and support groups is also crucial.

Understand the risk factors for depression, such as a history of depression, stroke severity, functional dependence, and cognitive impairment

Understanding the risk factors for depression after a stroke is crucial to managing the condition. Here are some of the key risk factors to be aware of:

• History of depression: Previous history of depression is a significant risk factor for post-stroke depression. Individuals with a history of depression are more likely to experience depressive episodes following a stroke.
• Stroke severity: The severity of the stroke plays a role in the development of post-stroke depression. Major strokes are more likely to lead to depression than mild strokes.
• Functional dependence: Post-stroke depression is often associated with functional dependence, where individuals become reliant on others for activities of daily living.
• Cognitive impairment: Cognitive impairment, such as difficulties with memory, concentration, and decision-making, is a risk factor for post-stroke depression.

Additionally, other factors such as age, gender, initial stroke severity, urinary incontinence, and social environment can also influence the development of post-stroke depression.

Seek professional help, such as from a psychologist or psychiatrist, and consider treatment options, such as medication or psychotherapy

Depression is a common experience for stroke survivors. It is often caused by biochemical changes in the brain. When the brain is injured, you may not be able to feel positive emotions.

If you are experiencing depression after a stroke, it is important to seek professional help. A good psychologist or psychiatrist can help. Treating depression not only improves your mood, it also boosts physical, cognitive and intellectual recovery.

There are many treatment options available. Depression is often treated with medication (antidepressants) and/or psychotherapy. Antidepressants can effectively treat moderate to severe depression, and some anxiety disorders. They may also have a positive effect on physical recovery. The two most frequently prescribed drugs for treating depression are selective serotonin re-uptake inhibitors (SSRIs) and tricyclic antidepressants. However, medication does not have an immediate effect. The symptoms usually begin to improve within the first six to eight weeks.

Psychotherapy can also help relieve post-stroke depression. Cognitive behavioural therapy (CBT) and interpersonal therapy (IPT) are effective treatments.

Make lifestyle changes, such as improving your diet, limiting caffeine and alcohol intake, and engaging in physical activity

Improving your diet

Making changes to your diet can help improve your mood and energy levels. Try to eat regular meals that include lots of fruit and vegetables. Reducing your alcohol and caffeine intake can also help, as these can alter your mood and affect your sleep.

Limiting caffeine and alcohol intake

Caffeine and alcohol can alter your mood and affect your sleep, so reducing your intake of these substances may help to improve your mood and energy levels.

Engaging in physical activity

Being physically active can help to lift your mood, as it encourages your brain to release chemicals that make you feel happier. Even a short walk or some chair-based exercises can have a positive effect.

Join a support group to connect with others who are going through similar experiences

Joining a support group can be a great way to connect with others and feel less alone in what can be an isolating experience. Support groups provide an opportunity to share your experiences and learn from others who are going through similar challenges. Here are some reasons why joining a support group can be beneficial:

Counter Loneliness and Isolation:

After a stroke, it is common to feel lonely and isolated, especially if you are facing a range of disabilities. Support groups provide a sense of community and connection with others who understand what you are going through. This can help reduce feelings of loneliness and isolation, knowing that you are not alone in your struggles.

Non-Judgmental and Compassionate Space:

Support groups offer a safe and non-judgmental environment where you can openly express your feelings and emotions without fear of being judged. You can share your challenges, concerns, and experiences with others who can empathize and provide support. This sense of understanding and acceptance can be comforting and help improve your mental well-being.

Improve Coping Skills:

Interacting with others in a support group can provide you with valuable insights and strategies for coping with the changes and challenges post-stroke. You can learn from others' experiences and gain practical tips for adjusting to your new situation. Hearing how others manage their difficulties can empower you and give you a sense of control over your recovery.

Reduce Stress, Anxiety, and Depression:

Sharing your experiences and emotions in a supportive environment can help reduce stress, anxiety, and depression. Knowing that you are not alone in your struggles can be comforting and uplifting. Additionally, support groups can provide you with tools and techniques to manage and reduce these negative emotions, improving your overall mental health.

Access to Information and Resources:

Support groups often serve as a hub of information and resources. You can gain access to valuable knowledge about doctors, treatments, and community resources that can aid in your recovery. Hearing about others' experiences with different healthcare professionals or treatments can provide you with insights and options that may benefit your own journey.

Make New Friends:

Joining a support group allows you to connect with people who are going through similar experiences. These connections can lead to meaningful friendships and a sense of camaraderie. Having friends who understand your challenges can provide ongoing emotional support and help you feel less alone during your recovery.

Overall, joining a support group can offer a range of benefits that can improve your mental and emotional well-being after a stroke. It is an opportunity to connect, learn, and grow with others who understand your struggles and can provide support, encouragement, and practical advice.

Frequently asked questions