Sunday, May 19, 2019

Helping Others Understand: Post-Stroke Depression

United Stroke Alliance in partnership with Medtronic launched a new resource for Stroke Support Groups called The Booster Box. Included in the box is everything a leader needs to conduct a support group meeting for up to 24 attendees.

To receive your free Booster Box please call our office at 
309-688-5450 or email to request yours. 

Subscriptions will be available for purchase and information will be inside your free box.  

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The best way to read this article on a cell phone is to hold your device horizontal (as if the longest side is on your lap). 
Helping Others Understand: 
Post-Stroke Depression

Helping Others Understand is an open-ended, intermittent series designed to support stroke survivors and family caregivers with helping friends and family better understand the nuances, complications and realistic expectations for common post-stroke conditions. If there is a specific post-stroke condition you’d like to see us address in future issues, we invite you to let us know:
Depression is common after stroke, affecting an estimated one-third to two-thirds of all survivors. Post-stroke depression (PSD) can occur on a continuum, from mild symptoms, often referred to as adjustment-related depression, to clinical depression, also known as major depressive disorder. In the early phases of stroke recovery, a reactive or adjustment-related depression can present as the survivor begins to come to terms with how the stroke might change their life. Chronic depression, (i.e., major depressive disorder) most often occurs when survivors return home and is often related to quality-of-life experience. “Post-stroke depression requires appropriate assessment. It’s essential to spend time with the stroke survivor to accurately evaluate the individual neurological and other factors,” said Kimberly McGuire, Ph.D., ABPP, clinical psychologist at Kessler Institute of Rehabilitation. “Typically, what we see in the acute rehabilitation setting is a combination of both the neurological changes that have occurred as the result of the stroke and the patient’s awareness of his or her limitations.”

Recognizing the signs of depression

The symptoms of post-stroke depression may vary and change over time, but generally patients and families should watch for:
  • Persistent sad, anxious or “empty” mood
  • Depressed mood; loss of interest/pleasure
  • Sleep disturbance
  • Decreased motivation
  • Flattening of affect
  • Feelings of hopelessness, pessimism
  • Feelings of guilt, worthlessness, helplessness (feeling like a burden)
  • Decreased energy, fatigue, being “slowed down”
  • Difficulty concentrating, remembering, making decisions
  • Appetite disturbance
  • Thoughts of death or suicide
When five or more of the above symptoms persist for two or more weeks, a survivor may be experiencing post-stroke depression.
The consequences of untreated PSD include prolonged hospitalization, difficulty with social integration and potentially limited functional recovery. Therefore, it is important to identify and treat PSD as soon as possible.

Understanding how to help

A survivor’s depression can significantly impact family and caregivers. “In my clinical experience, family and friends often develop a sense of helplessness when the survivor’s interest and motivation are impacted negatively,” said McGuire. “The family may begin to feel like they can’t do anything to help this formerly independent and strong-willed person to get better. It’s very difficult for everyone involved to adjust to the situation,” explained McGuire. “However, the number one thing survivors want their families and friends to understand is that they are still the same person inside. And that they want to be treated with the same level of respect they had prior to the stroke. In particular, they don’t want to be infantilized or treated like a child.”
Ways in which family and friends can show their support and understanding include:
  • Be patient.
  • Don’t finish their sentences.
  • Talk to them, not at them.
  • Maintain eye contact.
“Interacting with a loved one who is experiencing depression requires patience, respect and simply slowing down, as well as having to repeat yourself without irritation,” McGuire said. “Recognize that the survivor is likely to be experiencing a lot of fatigue, especially in the acute phase of recovery. Overall, it is important for family members to communicate that they believe the survivor is the same person despite the challenges or limitations they now face.”

Dr. Kimberly McGuire

McGuire suggests that caregivers and family members can benefit from counseling, particularly if they are taking on additional roles and are feeling overwhelmed with adjusting to the new normal. “If the survivor is feeling misunderstood, then I would urge both survivor and caregiver to consider a few sessions of family therapy,” McGuire said. “It doesn’t usually need to be ongoing, only enough to understand the process of stroke recovery, gain information and talk about some of the strategies that can be helpful.”
Aphasia can create additional challenges for survivors with post-stroke depression. According to McGuire, different types of aphasia require different approaches to care and treatment. For example, if a stroke survivor is coping with expressive aphasia — the loss of the ability to produce language — the individual understands what is being said yet is often unable to produce a coherent verbal response. The most productive approach in these situations is to structure inquiries and dialogue that require only a yes/no response, such as, “Are you feeling sad today?” rather than “How are you feeling?” This approach allows the stroke survivor to respond by nodding their head, signaling thumbs up or down, using yes/no cards or writing an answer on a piece of paper.
Receptive aphasia presents different challenges as the stroke survivor has difficulty in understanding verbal or written information. “When dealing with receptive aphasia, we teach families to observe the survivor’s behaviors, including sleep patterns, eye contact when interacting with others, tearfulness, agitation, and/or engagement in therapies and other activities,” explained McGuire. “Their observations along with assessments by the clinical team can help to determine if the individual is experiencing post-stroke depression or if other factors are at play and what treatment and strategies to pursue.”
Both survivor and caregiver support groups can also be helpful because of the input from others who have walked this path. “I’m a huge advocate of support groups,” McGuire said. “In scientific literature, support is often cited as the number one predictor of positive progress. At Kessler Institute, for example, we run both inpatient and outpatient support groups for survivors and families/caregivers. Participants consistently express how important the shared information, encouragement and empowerment is to their own recovery. It’s a very productive experience, one that helps to ‘normalize’ life ahead. Knowing that you are not alone — that others are going through what you are going through goes a long way in coping effectively.”
McGuire emphasized two crucial points for caregivers to understand. “First, post-stroke depression is real. It is not that the survivor is being lazy or unmotivated. Second, PSD needs to be treated, and typically that is with a combination of medication and individual or group therapy. Without treatment, the survivor may face prolonged hospitalizations or rehospitalizations. It can also limit the ultimate level of functional recovery and definitely compromises the survivor’s social integration.”

...Continued next week

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