Depression

Authors: Ying Ying Kan, BSc OT; Chantal Barakat, BSc OT; Martine Sourdif, BSc OT

Anyone who has experienced a stroke would agree that it is a big life change. Suddenly daily activities like washing and dressing become a challenge. It is a very difficult experience that can affect your emotions.

After a stroke, you may experience rapid changes in mood. For example, you may feel happy, and then suddenly very sad. You may feel that your emotions are like a roller coaster. Some people might cry and laugh at inappropriate times.

Just like depression, these mood swings can appear when there is an injury to a specific area of your brain.

The time after stroke that depression can appear varies. Some people become depressed shortly after the stroke, in the hours or days later. Others will experience depression much later after stroke, after as long as 3 years.

It is possible that your mood swings or depression are effects of your stroke. There are two possible explanations of depression post-stroke.

• Injury to your brain
  Indeed, some areas of your brain control your mood and emotions. If one of these areas is affected by the stroke, it can lead to mood swings or depression.
  
  There are debates on whether the site of the lesion is related to depression. Some research indicates that individuals who have a stroke in a specific lobe (frontal) are more likely to experience depression. Other research argues that it is the side of the brain (left or right) where the stroke happened that matters.
  
  

• Changes in your life skills and abilities
  
  Changes in your physical abilities after a stroke can be very difficult to accept. You may find rehabilitation overwhelming. Everyday tasks now require extra efforts. These feelings of sadness can lead to depression.
  
  The real cause of depression is probably a combination of these two theories. That is, depression is due in part to the damages in the brain area and also due to the changes in your life skills and abilities caused by the stroke.
   

People who are depressed share some common traits such as:

- getting angry easily or crying easily.
- sleeping too much or too little.
- feeling down.
- being slow mentally.
- feeling guilty.
- feeling less hopeful about the future.
- not wanting to see friends.
- thinking about ending one's life.

 

It is often difficult to detect depression in a person that has had a stroke. After a stroke, most people will have physical and cognitive problems. Often the treatment will focus more on those two aspects and will forget to include the person's feelings. Sometimes, people who had a stroke have problems speaking or understanding words; this makes sharing feelings very hard. Thus, it is hard to detect depression as well. Family and close friends are often the first ones to detect signs of depression in their loved one. This is because they know the person better than any health care workers.

Your clinician may ask you a series of questions or have you fill out a questionnaire. This will help to identify any signs of depression.

Post-stroke depression is a fairly new subject in research. Some studies have tried to prove the efficacy of different treatment options, but without success. However, many things may help some people with depression feel better.

Your health care providers can help you or refer you to the right resource. Your family and friends can also assist you. Use the resources around you and accept help from other people.

There might be some available resources in your community (example: group therapy, meals on wheels). To find more information consult your National stroke association.

Resources in Quebec

Sure! Having proper meals and good sleep will give you more energy during your recovery. You may feel you are not hungry or you have difficulty sleeping. This is common with people who are depressed. 

12. Should I exercise?

Yes. It is important, however, to know your own abilities and limitations when you are exercising.
If your doctor agrees, you may start an exercise class. Exercising releases an hormone (endorphin) that will make you feel good.

For information about exercise after a stroke, see Aerobic Exercise Late After Stroke or Aerobic Exercise Early After Stroke.

Yes. It is possible that you may not feel motivated to go to your rehabilitation sessions. It is hard and demands a lot of energy. However, rehabilitation sessions will teach you many things that will help you feel independent (dressing, walking). You will be proud of yourself and feel more motivated.

Having a social life has been shown to have a positive impact on helping depression. It is very important that you continue having hobbies, such as playing cards, doing cross-words, or going outside. Your occupational therapist can show you possible ways to adapt your hobby, since certain activities may need to be modified after a stroke.

Support groups are available in some regions for people who have had a stroke. You can also find stories about people who have had problems similar to yours. Consult your National Stroke Association:

Canada: Heart and Stroke Foundation

Psychotherapy is a treatment for mood swings. It involves encouragement, talking about conflicts, and understanding problems. The goals of psychotherapy are to reduce the mood swings, improve social life, and improve work abilities.
We only have information from one study which evaluates the effectiveness of a specific type of psychotherapy, cognitive-behavioral therapy, as explained below:

Cognitive-Behavioral Therapy (CBT) is a therapy that teaches people how to change their thinking in order to change their behavior. One "high" quality study showed that cognitive-behavioral therapy is not effective to treat depression after a stroke. In the study, the researchers divided people who were depressed after their stroke into two different groups. One of the groups received cognitive-behavioural therapy and the other group did not. After 6 months of treatment the researchers found no difference between the two groups in the severity of depression. Click on this link to find more information about CBT. http://www.nacbt.org/whatiscbt.htm

Music therapy is the use of music to help people express their emotions. One study has found that music therapy may help to improve depression after a stroke. More research needs to be done before knowing the value of music therapy for reducing depression after a stroke. Click on this link to find more information about music therapy http://www.musictherapy.ca/musictherapy.htm#whatis

Indeed, being depressed may slow down your recovery. Depression may make you feel less motivated and more tired, and also may cause you to have trouble concentrating. All these symptoms of depression will slow down your recovery capacities. Many studies have shown that people with depression after a stroke do not get better as quickly as people who are not depressed. The extent to which depression can affect recovery is not really known. It seems that both physical loss and depression can act on recovery.

Some studies show that people who are depressed can get better. On average, the duration of major depression in people who have had a stroke is under a year. However, sometimes depression can return, so it is important to watch for the signs.

Recovery from depression after a stroke takes time. It can vary a lot from one person to another. For example, medication can take a few weeks to work. With treatment, people who are depressed usually get better. As mentioned above, the average duration of major depression for people who have had a stroke is a year.

Not everybody who is depressed will experience a stroke. However, some studies have shown that being depressed may increase the chances of having a stroke. When heart disease, hypertension, diabetes, and tobacco use are all ruled out, depressed people are 2.6 times more likely to report a stroke.

Yes, if you were depressed before your stroke, you have more chances to be depressed after. This is one of the risk factors linked with depression after the stroke.

The care provider is the one who takes care of the person who has had a stroke. Usually this person is a family member, a spouse, or a close friend. Often, the care provider will be so devoted to their loved one that they will forget to take care of their own needs.

When your loved one is depressed after a stroke, it is more difficult for both of you to stay positive, so it is especially important that you both receive support. Thus, it is very important that you, as a care provider, take time for yourself everyday. Find a moment during the day to do an activity you like such as reading or shopping. Moreover, you should continue to see your friends to share your feelings and refresh your mind.

Understanding how depression and stroke happen can reassure you. There are many resources online. Your health care provider can help answer your specific questions.