Regaining physical strength and abilities after having a stroke can be difficult — but regaining mental and emotional health poses challenges as well.
People who survive a stroke may experience a range of neuropsychiatric disorders during their recovery, such as apathy, depression, anxiety, irritability, post-traumatic stress disorder, and delusions and hallucinations. But the most common of these is depression, which affects more than half of patients.
Stroke survivors who become depressed experience a slower rate of physical recovery, poorer quality of life, and increased disability, research shows. Such individuals are also more likely to have cognitive impairment, poor concentration and attention span, and reduced motor and executive functioning. And the risk of death and suicide is higher in stroke survivors who suffer from depression.
Early treatment is critical for recovery from the effects of a stroke, so psychological assessments are essential in order to identify depression or any other mood disorder.
Why depression is underdiagnosed
Distressing to stroke survivors and their families alike, depression and other mood disorders are not always easy to recognize in someone who has had a stroke.
What adds to the challenge of evaluating these syndromes in stroke patients is that the conditions are not solely the result of psychologically adjusting to the disability. The physiological effects of a stroke—damage to the frontal regions of the brain that control emotions—can lead to depression and other mood disorders.
Studies have found that post-stroke depression often goes undiagnosed, and many patients aren’t receiving necessary treatment as a result. For example, a study published in the journal Stroke in 2012 found that stroke patients had a high frequency of newly diagnosed depression at three and 12 months after hospitalization, but nearly 68 percent of patients with persistent depression were not using antidepressants at either time point.
Besides an initial assessment and treatment, stroke patients need continued monitoring to evaluate their mental health. One major concern is that stroke patients who are depressed may commit suicide. More than 7 percent of 38,000 stroke patients followed in a 25-year-study died by suicide, according to a review of research published in CNS Neuroscience & Therapeutics in 2012.
Because of this risk, researchers recommend that patients be closely monitored for depression and suicide for five years after a stroke.
Stroke patients who suffer from depression are treated in much the same way as anyone else with depression. Studies show that antidepressant medications not only improve mood but may also speed recovery and reduce the risk of death. Talk therapy alone or, preferably, in combination with medication, can help as well.
For stroke patients who develop depression during the early stages of their recovery, antidepressants have been shown to improve motor skills, verbal and visual memory scores, and activities of daily living. But timing is a critical factor in the effectiveness of antidepressants in treating stroke survivors.
In one study of 34 stroke patients treated with antidepressants, those who took the drugs within one month of their stroke showed higher levels of daily general functioning, compared to those who initiated treatment 140 days after their stroke.
Because treatment for depression can affect the way people function both physically and mentally after a stroke, it is critical that patients, family members, and caregivers report any behavioral or emotional changes to the doctor and get a referral for a psychiatric evaluation.
As the research indicates, the sooner treatment for depression begins, the better the outcome will be for the patient.
Read more about how to prevent depression relapses.