Treatment for Post-Stroke Depression

Strokes can be mild with minimal noticeable effects, or can have a devastating impact on the quality of life. Physical effects can include weakness, fatigue, pain, trouble swallowing, perceptual problems, including impaired distance and spatial judgment, sensory disturbance, thinking and memory problems, difficulty with speech or writing, depression and problems controlling feelings. The nature of the effects and severity of the impact of the stroke will depend on the amount of tissue damage and where in the brain the stroke occurred.

Effects

• According to UIHealthcare.com, about half the people who survive a stroke suffer from post-stroke depression. Depression can occur because of damage caused by the stroke to areas of the brain that regulate emotions, or can occur as a response to the effects of the stroke and the sudden changes in energy, abilities, feelings, perceptions, and independence that the stroke victim must adjust to. Dealing with post-stroke depression requires dealing directly with the depression, but also with the manifold effects of the stroke.

Evaluation

• As soon as possible after the stroke, obtain a comprehensive neurological and psychological evaluation of the stroke patient. A stroke will have different effects on different people depending on the location, nature, and extent of damage to the brain, idiosyncrasies of the brain structure, and collateral damage to surrounding regions of the brain.

  This evaluation should assess all aspects of behavior that are potentially affected by the brain injury. Testing should assess motor function, emotional functioning, problem solving, memory, speech, language, language-related movement, judgment, impulse control, spontaneity, and social behavior. Control of facial expressions, fine movements and strength of arms, hands and fingers, and ability to execute complex chains of motor movements should all be evaluated.

Treatment Planning

• Once areas of strength and weakness have been identified, an individualized rehabilitation plan should be developed. The treatment plan should incorporate specific plans to address each of the problems identified in the evaluation, but also should include strategies to deal with more general recovery and emotional adaptation issues. If depression is an identified issue, then a psychologist or therapist should become involved in treatment.

  Often, admission to a reputable brain trauma recovery unit with a competent staff will be the most effective way to affect recovery and improve depression. Individually tailored treatment should be implemented as quickly as possible after the stroke. Specialists trained in speech, language, motor and occupational behavior, psychology, and pain management, work as a team with neurological and medical practitioners to address the stroke patients’ individualized needs. Rehabilitation works to reorganize neural communication and brain organization, alter brain chemistry and cell efficiency, and “reassign” brain functions. Rehabilitation helps people relearn cognitive skills and compensate for deficits. These efforts can help restore function, confidence, and improve depression.

Implement Comprehensive Treatment

• Rehabilitation may continue for months, or even years. Therapy, medications and other treatments for depression should be implemented from the get-go and should be continued as necessary.

  The stroke survivor can take medications that improve functioning of the areas of their brain that were affected by the stroke, such as stimulants to improve frontal lobe functioning, but also can take antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), that can improve depression. Strokes do not prohibit the use of antidepressants. As should always be the case with psychotropic drugs, careful supervision and monitoring of side effects should be maintained.

  Family members, along with professional mental health providers, should provide emotional and social support to the stroke patient. The patient may require more support and understanding than was necessary before the stroke. He may become demanding and prone to emotional outbursts, or he may become less communicative and withdrawn. In either case, support from family and friends is critical to rehabilitation. Family members should communicate with the patient frequently, check on his status, and if possible, communicate with other caregivers regarding their observations of the patient’s status and well being.