Post Stroke Depression: Recognition and Treatment

Many stroke survivors experience feelings of anger, frustration, anxiety, sadness, fear, and hopelessness. Since stroke leads to a major change in a patients ability to cope with activities which we normally take for granted , these emotions are common  post-stroke and affects more than one third of stroke survivors

HOW TO RECOGNISE POST STROKE DEPRESSION

To recognizing post stroke depression, a stroke survivor should be evaluated for depression if he/she had several of these symptoms for more than two weeks. 

Warning symptoms of depression after stroke

• Feelings of helplessness, hopelessness, and/or worthlessness.
• Loss of interest in life, activities or hobbies.
• Social withdrawal.
• Persistent sad, anxious or empty feelings.
• Sleep disturbances
• Difficulty concentrating or remembering details 
• Expressing of dying and suicidal thoughts.
• Aches, pains, headaches and digestive problems that do not ease with treatment.
• Frequent crying episodes
• Poor appetite or decrease in appetite

Can post stroke depression be treated ?

Untreated depression can lead to worsening of nutrition, incontinence, pain , fatigue and sleep pattern. Depressive thoughts can increase frustration and lead to poor interest in physical and speech therapy which is essential for speedy recovery.  There are a various options  for treatment of post-stroke depression. Consult with your healthcare professional to determine the best course of action. Common treatments include:

• Medication - Medications known as antidepressants are common treatments for post-stroke depression .  Antidepressant medications interact with chemicals in the brain called neurotransmitters to improve mood. Most of them act by increasing the serotonin levels in brain
• Cognitive behavioral therapy- This therapy works on identification of feelings and thoughts which lead to development of depression  
• Mental Health Therapy - Medication is often combined with mental health therapy provided by a psychologist, psychiatrist, social worker, or counsellor.

Role of Nutrition 

Serotonin is a chemical secreted by the brain which controls our appetite and our emotions too. Improving nutrition and increasing food rich in omega 3 fatty acid, vitamin B , folic acid and complex carbohydrates helps in fighting depression and improvement of mood

• Fish, flaxseed, walnuts are rich in omega 3 fatty acids and improve brain health
• Brown rice, oatmeal and whole wheat boost neurotransmitter chemicals in the brain that affect mood.
• Dark chocolate helps fight fatigue and reduce stress.
• A deficiency in folic acid (found in beans, oranges, and broccoli) is linked to depression; folic acid boosts neurotransmitters and promotes cognition.
• Vitamin B12 (eggs, milk, liver) increases energy and alertness.

How can caregivers help in fighting post stroke depression

• Encourage a structured routine increasing walking, regular physical and speech therapy as well as gradually developing in activities of daily living like eating bathing etc.
• Keep patient upbeat and encourage but have realistic expectations about what can be achieved.
• Avoid daytime sleeping by a simple walk outdoor or sometime in the garden, which can really help.
• Evaluation by health care provider to asses need for medications (pharmacotherapy and psychotherapy) for treatment of depression.