Poststroke depression
What is Poststroke Depression?
Poststroke depression (PSD) is a major depressive disorder following stroke that can cause considerable distress and disability for those affected. It is one of the most common psychological complications of stroke, occurring in up to one-third of stroke survivors.
PSD has both physical and emotional effects. It can affect stroke survivors’ ability to carry out everyday activities, and to participate in and enjoy life. PSD can also cause fatigue, low motivation, confusion, cognitive changes, irritability, and anxiety.
Causes of Poststroke Depression
The exact cause of PSD is unknown. However, some factors have been associated with the development of PSD. These include:
- Stroke-related neurological damage
- The presence of chronic pain
- The absence of therapeutic or emotional support
- Family history of depression
- Negative life events
- Changes in lifestyle
- Medication side effects
Symptoms of Poststroke Depression
The symptoms of PSD can be divided into physical and emotional. Physical symptoms may include:
- Lethargy and tiredness
- Sleep problems (such as insomnia)
- Weight changes
- Difficulty with balance
- Difficulty with speech and language
- Increased sensitivity to pain
Emotional symptoms of PSD may include:
- Sadness and tearfulness
- Low self-esteem
- Difficulty concentrating
- Anxiety
- Lack of motivation
- Feelings of guilt, worthlessness, and helplessness
- Reduced interest in previously pleasurable activities
Diagnosing Poststroke Depression
PSD can be difficult to diagnose, and often the signs and symptoms are misunderstood. In some cases, PSD can be overlooked as it may be mistaken for other causes of distress, such as dementia or physical disability. It is also important to differentiate between “normal” reactions to stroke, such as sadness, and pathological symptoms of depression.
Diagnosis involves a physical and psychological assessment. Patients should be asked about symptoms, history of depression, stroke severity, and other psychological factors.
Treatment of Poststroke Depression
Treatment for PSD may involve medications, psychotherapy, or both. The type of treatment used depends on severity and other factors. Other treatments may include lifestyle changes, such as physical activity and nutrition, or support programs.
Medications can help manage PSD symptoms, by altering the levels of neurotransmitters in the brain. These medications can have side effects, so closely monitoring and adjusting dosage may be necessary.
Psychotherapy may include cognitive-behavioral therapy, interpersonal therapy, or a combination of both. This type of therapy can help stroke survivors to adjust to changes in their lives, adjust their thinking patterns, and develop strategies for coping with daily life.
Support groups or programs, such as counseling, peer support, or art therapy can also be beneficial for stroke survivors with PSD. They can provide an opportunity to socialize, which can help combat feelings of isolation or loneliness. They also provide a supportive environment in which stroke survivors can ask questions, get feedback, and find comfort in knowing they are not alone.