Depression after a stroke is not uncommon and is perfectly understandable, but it is a clinical condition that is more serious than feeling sad or very upset with a loss of independence. Up to one out of three stroke survivors experiences some symptoms of depression sometimes after their stroke, a fraction of them will even experience severe depression.

These symptoms can occur right after the stroke, during rehabilitation or once you get home. The size and location of the stroke, previous or family history of depression and pre-stroke social functioning all seem to affect the likelihood and severity of post-stroke depression. Identifying the signs of depression early and dealing with it appropriately is important to maximize the post stroke recovery.

What follows is a list of useful advices to keep an eye on depression and address it promptly.

1. DEPRESSION MUST BE IDENTIFIED AND ADDRESSED THE SOONER THE BETTER.
Depression can cause behavioral and personality changes in stroke survivors and, unfortunately, stroke recovery can also be negatively affected, especially by major depression, as it can cause them to loose motivation and to become less compliant with their rehabilitation program. In fact, several medical studies have concluded that depression can delay or damage the prospects of stroke recovery. It is thus very important to identify and address depression. Yet there is no need to worry: there are ways to recover!

START BY KNOWING ITS SYMPTOMS.
A stroke may cause dramatic changes in your behavior or diminish your ability to function or communicate, and thus make it hard for people around you to distinguish disability from depression. Depression is thus commonly viewed as a natural or inevitable response to the effects of the stroke and often left undiagnosed and untreated. However, depression is a separate illness that can be treated successfully with the help of friends, family, support groups and professional care.

The National Institute of Mental Health recommends that anyone experiencing five or more of the following symptoms for more than two weeks should seek a medical evaluation for depression:

• Persistent sad or “empty” mood
• Feelings of guilt, worthlessness, helplessness
• Loss of interest or pleasure in ordinary activities, including sex
• Decreased energy, fatigue, being “slowed down”
• Sudden trouble sleeping or oversleeping
• Sudden loss of appetite and weight, or weight gain
• Difficult concentrating, remembering, making decisions
• Irritability
• Excessive crying
• Chronic aches and pains that don’t respond to treatment
• Thoughts of death or suicide, suicide planning or attempts

If you feel suicidal contact your doctor or a mental health professional immediately and contact friends or family for company – anyone who feels suicidal should not be alone.

CHOOSE THE RIGHT TREATMENT AND GO AHEAD.
The treatment of post-stroke depression depends on its severity. Normally we separate between reactive depression and major depression. Reactive depression describes a depressed state that occurs after an event or change. The common theme is a state of transition and hence it is common after a stroke. Reactive depressions are less severe than major depression. Its treatment may involve talking therapies, which can be obtained from rehabilitation counselors, psychologists, psychiatrists and general practitioners. Major depression describes a state of low mood or a loss of enjoyment of daily activities. Its management will involve the use of medication, normally in combination with talking therapy. Major depression may occur in combination with reactive depression.

KEEP YOUR DOCTOR INFORMED OF ALL MEDICATIONS YOU ARE TAKING.
If on medications it is important that all doctors are aware of all of the medications that have been prescribed to avoid unfavorable interactions. This is very important as some medicines commonly used to treat depression are dangerous for stroke survivors and other common post-stroke medicines can deepen depression. Always using the same pharmacy, allowing for the pharmacist to alert your doctor of potential problems, could thus be a good idea.

Here are some activities that may help stroke survivors avoid or fight against depression:

• Make the most of your rehab: the more you recover, the better you will feel and the better you feel the more motivated you will be for you rehab exercises (in this way you are creating a virtuous cycle) – however it is essential to look at the progress over longer periods (month) as it is not visible on a day-to-day basis. At the same time it is important to realize that adequate therapy for depression can trigger rehab activities.
• Get involved in daily activities with friends or family. Many stroke survivors feel isolated and alone, even if they aren’t physically incapacitated from the stroke.
• Ask your family to stimulate your interest in people and social activities.
• Set goals and measure accomplishment.
• Plan daily activities to provide structure and sense of purpose.
• Join a stroke support group. Other survivors will understand your issues, and offer support and ideas to help you manage your emotions.
• Speak openly and honestly to your caregivers about your emotional changes. They’ll be glad you did, and together you can work out a solution.
• Maintain your quality of life by staying active and doing things you enjoy
• If you’re capable of volunteering, even if it’s just an hour or two a week, it will not only help others, but could also help you feel better about yourself.
• Ask your doctor how to relieve any physical discomforts like pain, muscle spasms, and constipation that can all add to depression.

In any case, it is important to acknowledge that recovery from depression takes time, even some anti-depressants take several weeks before they begin to help. It takes much of your own effort and decisiveness, and it is perfectly possible and expected that you will get over it and move on in your stroke recovery.

Depression after a stroke is not uncommon and is perfectly understandable, but it is a clinical condition that is more serious than feeling sad or very upset with a loss of independence. Up to one out of three stroke survivors experiences some symptoms of depression sometimes after their stroke, a fraction of them will even experience severe depression.

These symptoms can occur right after the stroke, during rehabilitation or once you get home. The size and location of the stroke, previous or family history of depression and pre-stroke social functioning all seem to affect the likelihood and severity of post-stroke depression. Identifying the signs of depression early and dealing with it appropriately is important to maximize the post stroke recovery.

What follows is a list of useful advices to keep an eye on depression and address it promptly.

1. DEPRESSION MUST BE IDENTIFIED AND ADDRESSED THE SOONER THE BETTER.
Depression can cause behavioral and personality changes in stroke survivors and, unfortunately, stroke recovery can also be negatively affected, especially by major depression, as it can cause them to loose motivation and to become less compliant with their rehabilitation program. In fact, several medical studies have concluded that depression can delay or damage the prospects of stroke recovery. It is thus very important to identify and address depression. Yet there is no need to worry: there are ways to recover!

START BY KNOWING ITS SYMPTOMS.
A stroke may cause dramatic changes in your behavior or diminish your ability to function or communicate, and thus make it hard for people around you to distinguish disability from depression. Depression is thus commonly viewed as a natural or inevitable response to the effects of the stroke and often left undiagnosed and untreated. However, depression is a separate illness that can be treated successfully with the help of friends, family, support groups and professional care.

The National Institute of Mental Health recommends that anyone experiencing five or more of the following symptoms for more than two weeks should seek a medical evaluation for depression:

• Persistent sad or “empty” mood
• Feelings of guilt, worthlessness, helplessness
• Loss of interest or pleasure in ordinary activities, including sex
• Decreased energy, fatigue, being “slowed down”
• Sudden trouble sleeping or oversleeping
• Sudden loss of appetite and weight, or weight gain
• Difficult concentrating, remembering, making decisions
• Irritability
• Excessive crying
• Chronic aches and pains that don’t respond to treatment
• Thoughts of death or suicide, suicide planning or attempts

If you feel suicidal contact your doctor or a mental health professional immediately and contact friends or family for company – anyone who feels suicidal should not be alone.

CHOOSE THE RIGHT TREATMENT AND GO AHEAD.
The treatment of post-stroke depression depends on its severity. Normally we separate between reactive depression and major depression. Reactive depression describes a depressed state that occurs after an event or change. The common theme is a state of transition and hence it is common after a stroke. Reactive depressions are less severe than major depression. Its treatment may involve talking therapies, which can be obtained from rehabilitation counselors, psychologists, psychiatrists and general practitioners. Major depression describes a state of low mood or a loss of enjoyment of daily activities. Its management will involve the use of medication, normally in combination with talking therapy. Major depression may occur in combination with reactive depression.

KEEP YOUR DOCTOR INFORMED OF ALL MEDICATIONS YOU ARE TAKING.
If on medications it is important that all doctors are aware of all of the medications that have been prescribed to avoid unfavorable interactions. This is very important as some medicines commonly used to treat depression are dangerous for stroke survivors and other common post-stroke medicines can deepen depression. Always using the same pharmacy, allowing for the pharmacist to alert your doctor of potential problems, could thus be a good idea.

Here are some activities that may help stroke survivors avoid or fight against depression:

• Make the most of your rehab: the more you recover, the better you will feel and the better you feel the more motivated you will be for you rehab exercises (in this way you are creating a virtuous cycle) – however it is essential to look at the progress over longer periods (month) as it is not visible on a day-to-day basis. At the same time it is important to realize that adequate therapy for depression can trigger rehab activities.
• Get involved in daily activities with friends or family. Many stroke survivors feel isolated and alone, even if they aren’t physically incapacitated from the stroke.
• Ask your family to stimulate your interest in people and social activities.
• Set goals and measure accomplishment.
• Plan daily activities to provide structure and sense of purpose.
• Join a stroke support group. Other survivors will understand your issues, and offer support and ideas to help you manage your emotions.
• Speak openly and honestly to your caregivers about your emotional changes. They’ll be glad you did, and together you can work out a solution.
• Maintain your quality of life by staying active and doing things you enjoy
• If you’re capable of volunteering, even if it’s just an hour or two a week, it will not only help others, but could also help you feel better about yourself.
• Ask your doctor how to relieve any physical discomforts like pain, muscle spasms, and constipation that can all add to depression.

In any case, it is important to acknowledge that recovery from depression takes time, even some anti-depressants take several weeks before they begin to help. It takes much of your own effort and decisiveness, and it is perfectly possible and expected that you will get over it and move on in your stroke recovery.