Treat Depression After a Stroke to Optimize Recovery

As long as you are having depression treated the right way. Not talk therapy or meditation, real drugs. But don't listen to anything I have to say, I'm not medically trained. But I bet your doctor hasn't read this research.

Common antidepressant can help stroke patients improve movement and coordination Sept. 2015 

Antidepressants may help people recover from stroke even if they are not depressed Jan. 2013

Treat Depression After a Stroke to Optimize Recovery

Nearly 800,000 people suffer a stroke annually in the U.S., according to the Centers for Disease Control and Prevention. This occurs most commonly when a clot cuts off the blood supply to an area of the brain -- called an ischemic stroke -- or a blood vessel bursts in the brain (a hemorrhagic stroke).

Resulting in 130,000 deaths each year, stroke can cause profound changes in the brains of survivors as well. Many face an arduous road to recovery. Depending on the severity of the stroke and its location in the brain, its effects can range from paralysis of one side of the body to difficulties with speech and memory loss. But intensive rehab including physical, occupational and speech therapy can improve recovery of function.

Complicating matters, however, is the fact that many patients suffer depression following a stroke. The common mood disorder can undermine a person's motivation and ability to engage in rehab during the most critical period following the stroke, experts say, when patients need to put everything they have into recovery. A large Danish study published in the journal JAMA Psychiatry in October found that the rate of depression in the three months following a stroke was eight times higher than for the general population who hadn't suffered a stroke. In all, the study of more than 157,000 hospitalized stroke patients found that one-quarter -- or about 25 percent -- experienced depression within two years, compared with about 8 percent of the general population. A history of depression as well as the severity of a stroke increased the risk of a person developing depression, and those suffering from depression after a stroke were more likely to die from any cause.

[See: 10 Ways to Lower Your Risk of Stroke.]

Stroke Takes a Mental Toll

The rate of depression after a stroke even exceeds the heightened rate of depression people suffer after another life-changing event: a heart attack. "It seems that some imbalance in the brain induced by the stroke may cause stroke patients to be more susceptible to depression," lead study author Terese Sara Høj Jørgensen , a doctorate student at the University of Copenhagen in Denmark, wrote in an email. Though more research is needed to understand exactly what explains the higher rate of depression after stroke, clinicians say the link shouldn't be glossed over.

"It's a mistake to make the assumption that the patient is depressed because they've had a stroke and this is their reaction to the stroke," says Dr. Michael Waters, director of the stroke program and neurovascular division at Barrow Neurological Institute at St. Joseph's Hospital and Medical Center in Phoenix. Though patients may certainly react negatively to the loss of function after a stroke, depression rates go down in the year or two after a stroke, as compared with the especially high incidence of depression in the months following.

"People should be aggressive about treating the depression itself," Waters says. "Not only will it improve the mood of the patient, but it will improve their ability to rehab and re-attain maximum function after the stroke." Most of what patients will recover following stroke, in terms of function, they get back within the first 30 to 90 days, Waters say. So early treatment and rehab is crucial, though he also emphasizes that patients who continue to challenge themselves can see lifelong improvements.

[See: Easy Ways to Protect Your Aging Brain.]

Get Treated for Depression

The American Heart Association and American Stroke Association recommend stroke survivors be periodically screened and evaluated for depression. The AHA and ASA advise that people with post-stroke depression be treated with antidepressant medications, especially selective serotonin reuptake inhibitors, or SSRIs; the associations note that a review of research found no evidence of a benefit from psychotherapy in treating depression after a stroke. But experts say more study is needed to understand the best way to treat stroke-associated depression.

Stroke survivors should also seek to reintegrate into their social networks, with assistance from caregivers and families, to help protect against depression and bolster recovery. "Patients who are more socially isolated ... don't do as well after stroke," says Dr. Monica Verduzco-Gutierrez, medical director of the brain injury and stroke program at TIRR Memorial Hermann, a rehabilitation hospital in Houston. Experts suggest joining patient support groups as well, to learn from and lean on other stroke survivors during the recovery process.

Verduzco-Gutierrez notes that when stroke survivors who suffer from depression are treated, they start recovering at the same rate as stroke survivors without depression. But depression associated with stroke often goes untreated. "Despite its high frequency and importance, depression remains grossly underdiagnosed and poorly treated in patients with stroke," Dr. Craig S. Anderson, a professor of stroke medicine and clinical neuroscience at the University of Sydney in Australia, wrote in an editorial accompanying the study on depression following stroke in JAMA Psychiatry. "Certainly a greater awareness of stroke-associated depression among patients, families and health professionals could facilitate recognition, earlier treatment and improved outcomes."

There's some indication, too, that it may be possible to prevent depression following a stroke. "A few recent studies indicate that patients might decrease their risk of depression early after stroke by using anti-inflammatory treatment such as aspirin or statins," Jørgensen says. Clinicians advise that stroke survivors and their advocates discuss all treatment options -- including prevention -- with their health providers, and that patients follow recommended treatment protocols.

[See: 17 Ways Heart Health Varies in Women and Men.]

Because mental health concerns may be overlooked while health providers attend to other aspects of stroke rehab, experts reiterate that survivors and their families should insist on early evaluation and diagnosis of depression following a stroke. "We need to get these patients assessed and treated expeditiously," Verduzco-Gutierrez says, to improve recovery as well as long-term survival.

Michael Schroeder is a health editor at U.S. News. You can follow him on Twitter or email him at mschroeder@usnews.com.