My response was:
Depression wouldn't be so bad if our doctors/researchers would stop the neuronal cascade of death. Thus resulting in vastly less disability. I know that Dr. Tymianski has talked about 1000+ neuroprotective trials that have failed. That is no reason to give up. There are only 5 currently known causes to solve:
1. glutamate poisoning
2. excitotoxicity
3. Capillaries that don't open due to pericytes
4. Inflammatory action leaking through the blood brain barrier.
5. Lysosomal Membrane Permeabilization as a Key Player in Brain Ischemic Cell Death
http://www.dailyherald.com/article/20160213/entlife/160219936/#articlecomments
Q: My mother had a
stroke that weakened one side of her body. But the bigger problem right
now is her depression. Can that be treated, or is it caused by
irreversible brain damage from the stroke?
A: Strokes can cause significant
problems. People can have difficulty moving (like your mother). They can
have trouble speaking or understanding speech. They can have trouble
thinking. Being suddenly hit with any or all of those losses would
depress anyone -- including people who never suffered from depression
before.
About one in four people who've
had a stroke develop major depression. In part, this is a reaction to
the terrible losses caused by a stroke. But you're right that the injury
to the brain from the stroke can itself cause changes in brain
chemistry that lead to depression.
In other words, depression
following a stroke can be similar to depression following another major
illness that affects a person's life but does not injure the brain --
such as a heart attack or cancer. But it also can be caused by the brain
injury itself.
You might think that in someone
who has difficulty talking or understanding speech, or difficulty moving
her arms and legs, depression is the least of her problems. But the
mental anguish of depression isn't a minor concern.
Left untreated, depression can undermine efforts at rehabilitation and worsen cognitive disabilities.
Depression after a stroke is
associated with poorer outcomes a year after the stroke has occurred.
It's also associated with a higher death rate in subsequent years.
Fortunately, antidepressants seem
to be fairly effective. In 2008, scientists published a review of the
research in this area. They concluded that the medications had a "small
but significant" effect on post-stroke depression.
What's more, the benefits of
antidepressants may not be limited to relieving depression; they may
positively affect areas and networks in the brain that improve other
impaired functions as well. Studies have found that certain
antidepressants, in combination with physical therapy, can help with
recovery from stroke-induced paralysis, muscle weakness and overall
disability.
If you haven't already done so,
talk to your mother's doctor about her depression. Ask the doctor to
recommend a psychiatrist who has experience working with stroke
patients, or find out if there is a mental health professional
affiliated with your mother's rehab program.
Treatment of stroke has improved
greatly in this country. Some people who would have died or been
severely disabled can now do quite well. That's due, in part, to
powerful drugs that can quickly open blocked blood vessels in the brain.
More recently, stents that grasp
and remove the blood clots that are blocking blood flow to the brain
have been found to be effective. They more than double the chance that a
patient with a stroke will become functionally independent.
Doctors who concentrate on
deploying all of these new treatments available for patients with stroke
can sometimes neglect to recognize and treat depression. If you think
that might be happening with your mother, raise that issue with her
doctor.
• Dr. Anthony Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.
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