Stroke patients can be at risk for depression

BY JIM HOWE

At least a third of people who have a stroke become depressed or show some symptoms of depression, according to an expert who often treats such patients.

It’s called post-stroke depression, explains rehabilitation psychologist Michelle Woogen, PsyD, who works in Upstate’s department of physical medicine and rehabilitation.

* a sad mood and possibly thoughts of wanting to die or commit suicide

*excessive crying

* feelings of worthlessness

* low motivation or energy

* changes in eating or sleeping behavior

* agitation

* loss of interest in activities the patient used to enjoy

* poor concentration or ability to make decisions

* physical: difficulty walking, talking and dressing

* mental: having trouble solving problems, remembering things, doing tasks like paying bills and knowing what’s safe and what isn’t.

It is believed that there are two reasons why someone may become depressed after a stroke: It may be in response to the stress of having a stroke in general, which is an upsetting experience, or it may be that as the brain is rewiring itself (and we know that our emotions are housed in our brain), it is accidentally rewiring itself to be more depressed. It could also be a combination of the two, Woogen said.

Strokes that limit patients’ ability to move around and take care of themselves on their own put those patients at a higher risk of developing depression, as do cognitive (thinking) difficulties and a history of depression.

Post-stroke depression can be tricky to diagnose, Woogen cautions, since something like sleeping more might simply be part of the recovery process.

“We are looking for symptoms of depression, but a brain injury can mimic those symptoms. The brain needs to sleep after injury. It’s easily fatigued, so they might be sleeping a lot, but maybe they are just recovering. They also might look like they have poor motivation, but that is also something that can be caused by brain injury. The brain has trouble telling the body to get going, so you have a plate of food in front of you, and you know it’s time to eat, but the brain is just not telling the body, ‘OK, pick up the fork, put the food on the fork, fork to the mouth,’ so it can be tricky,” she said.

“You don’t want to chalk these symptoms up just to the brain injury, but you also don’t want to panic and assume that any symptom is severe depression, because a stroke is upsetting. I expect there to be a degree of sadness there, and that’s OK when you notice that in yourself or your loved one after a stroke.”

Stroke patients are grieving the loss of their abilities, Michelle Woogen, PsyD so some sadness is to be expected. Depression can start right after the stroke or not show up for a year or more, she said, noting that stroke recovery typically takes one to two years.

When she visits with patients undergoing rehabilitation, “I am looking for something that shows me that they are also coping. So,

* are they also focused on the future, talking about wanting to get back to work, driving, being with their grandchildren?

* are they engaged in therapy, or do they just want to bury their heads in the covers all day and refuse therapy?

* are they able to focus on things other than the stroke, such as pleasant memories and how other people are doing, rather than being hyper-focused on the stroke?

“If they are able to have other conversations, that is a sign that they are coping, so I look for those as well.”

Post-stroke depression can limit a patient’s participation in rehabilitation, which is part of the process of the brain’s recovery; it interferes with people’s quality of life and their involvement in the community; it increases the need for medical visits; and it increases the risk of death and suicide, Woogen said.

If loved ones or caregivers see symptoms of depression after a stroke, Woogen advises talking with the patient’s physiatrist — doctor of physical medicine and rehabilitation — or, if the patient doesn’t have one, with the primary care provider. They can help figure out whether it’s depression and help recommend a treatment plan that might include a mood-stabilizing medication and/or seeing a mental health provider. “Sometimes, talk therapy is the best medication,” she said.

As patients receive treatment and support, the depression often lifts.

Woogen also treats people in rehab for a variety of traumatic and other brain injuries and works with their family members and caregivers.

Woogen noted the toll a stroke and post-stroke depression can take on family members and caregivers. “It’s hard to watch a loved one experience depressive symptoms, and it’s very easy to want to tell them that everything is going to be OK. That’s a good thing to say, and it’s also a good thing to sit with them and say, ‘I know this is hard, and I’m here with you, and you let me know if there is something that you need.’ Try not to just say everything is good again, because it’s not. They’re grieving, and that’s appropriate.” ●