May seems to be a very important “awareness” month in the United States, as it is both “Mental Health Awareness Month,” and “Stroke Awareness Month.” So in thinking about how these two important issues relate, it seems appropriate for me to mention a very common condition experienced by thousands of stroke survivors each year- Post-Stroke Depression (PSD). Estimates of prevalence, or how common, PSD is among survivors vary, but is generally found to be as many as 1/3 to 2/3 stroke survivors experience PSD at some point following stroke. Causes of PSD are not completely known, though hypotheses include the possibility of neurochemical alterations/changes in the brain (e.g. changes in levels of key chemicals such as serotonin or norepinephrine) that occur after stroke, as well as more “situational” issues such as adjusting to significant physical limitations or loss of independence. In reality, PSD probably occurs as a combination of neurochemical changes in the brain as well as psychological adjustment to loss.
So why is it so important to screen for PSD, and for stroke survivors and their families to be aware of this condition? When PSD is left untreated, it not only adversely impacts the stroke survivor’s quality of life, but it can actually delay meaningful improvements in function and progress through rehabilitation efforts!
The good news is that PSD is a very treatable condition. Generally speaking, antidepressant medications are the first-line of treatment for PSD. In my own clinical experience, survivors may not need medication for an extended period of time, but it can be very helpful to “get over the hump” initially. Antidepressants help to increase and stabilize certain chemicals in the brain believed to be related to mood. Additional treatments may include individual psychotherapy/counseling, particularly if depressive symptoms appear to be more related to adjustment to disability/loss. Other effective treatments may include increasing involvement in enjoyable activities (hobbies/interests) and improving social support.
The American Heart Association/American Stroke Association’s website has a lot of great information, including many inspirational stories told by stroke survivors. Sometimes the most powerful “treatment” for PSD may actually be the instillation of hope for the future- no matter the degree of disability. And there is nothing like hearing another stroke survivor tell his or her story.
BIND also works to improve the lives of individuals living with the effects of stroke through programs such as Peer Partners, a mentoring program provided by stroke survivors/caregivers for stroke survivors/caregivers. Feel free to explore our website for more information on our programs.
And if you or your loved one is living with PSD, I encourage you to get connected- explore area stroke support groups, talk to your doctor about treatment options, get involved with the AHA/ASA, or reach out to BIND!
~Dr. Kelley D. Beck, Board President