Stroke depression is a relatively new diagnosis. Stroke refers to a blood clot in the brain that causes an imbalance of oxygen and blood flow. When the flow is out of balance, cells are deprived of oxygen and other nutrients essential for their survival.
A stroke in the left hemisphere usually affects the left side of the brain, while a stroke in the right hemisphere generally affects the right side of the brain. Stroke depression can be difficult to diagnose. Post stroke depression has been recognized by psychiatrists for more than 100 years, but controlled systematic studies did not begin until in the 70s.
Post stroke depression occurs in a significant number of patients and constitutes an important complication of stroke, leading to greater disability as well as increased mortality.
There have been many case reports of
- Emotional upset
- Personality changes
- Sleep disturbances
- Memory problems
- Suicidal thoughts or attempts
In patients who suffered from post stroke depression following their stroke.
However, there are no agreed-upon criteria for defining or diagnosing post stroke depression. This may be because some of these symptoms mimic the early stages of depression, such as feelings of hopelessness or social isolation. There are several groups that have reported a significant association between stroke and depression
- Patients with mild or moderate ischemic heart disease
- Patients with hemiplegia or hemiparesis of the knee or hip
- Patients with ischemic heart rhythm (IHRT)
Ischemic heart disease is associated with a three-fold increase in the incidence of depression. Patients with IHRT have a two-fold increased risk. The association between IHRT and depression was more robust in women than in men.
Post Stroke Depression Symptoms
Symptoms that can occur in patients who have had a stroke and are later diagnosed with depression include
- Substance abuse
- Suicidal thoughts
- Decreased social function
In addition, patients with depression who become isolated or do not participate in any form of social activity are at a greater risk of developing suicidal thoughts or behaviours. Stroke survivors who also experience symptoms of suicide are at especially high risk.
Patients can experience symptoms of depression that may go undetected or untreated for long periods of time. The symptoms can negatively affect the quality of life. It is important to note that even though mood disorders are linked to more serious medical conditions, it is possible for them to be successfully treated in the treatment centres.
How to Treat Post Stroke Depression
Many times, patients who experience depression may need additional counselling to address their feelings of hopelessness and helplessness. Some research has shown that there may be a genetic component to some forms of poststroke depression.
There is some evidence to support the hypothesis that people who have a family history of depression are more likely to develop symptoms of this disorder. However, there is still no strong evidence that genetics directly cause strokes. Other research indicates that both cardiovascular and cerebrovascular disorders may play a role in the development of post-stroke depression.
Recovery from depression is not easy, and it can take several months or years to effectively return to daily functioning. With the previous findings, patients with post stroke depression who responded to treatment with nortriptyline or fluoxetine showed significantly better improvement in activities of daily living than patients with post stroke depression who did not respond to active treatment or placebo
Family support is very important during this time. This will allow caregivers to become familiar with the daily routines of their loved ones and to start to develop a sense of familiarity and trust. Many caregivers are surprised at how much they actually begin to trust their loved ones, once they begin to open up and share their own feelings and concerns about the recovery process.
In order to treat post stroke depression, patients need to be accurately diagnosed. Most of the patients have a somatic component to their symptoms, like pain, fatigue, or limited speech after a cerebrovascular event. These post stroke depression symptoms can confound a depression scale that accounts for somatic symptoms. Post stroke depression strongly affects the way patients participate in and respond to rehabilitation.
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