Monday, October 12, 2020

Depression and Stroke


The following is an article originally posted on the now discontinued website called StrokeNet. They published a monthly newsletter. Their articles are still very useful today. With the permission of their then editor, Lin Wisman, I am able to repost them on my site. 

David Wasielewski, the author of this article, was a member of the StrokeNet staff.
Depression and Stroke
By David Wasielewski


       Reactive vs Clinical

As stroke survivors we, and often our caregivers, are tasked with overcoming a variety of challenges. The physical challenges that can accompany a stroke are obvious to those around us. The mental and psychological challenges are less so. A common challenge that we often face following a stroke is depression.

To an outside observer depression is often perceived as a profound sadness or anger that overtakes an individual. To the individual experiencing depression the situation is rather one where they experience a lack of these and most any other emotion. It is described by some who have written about their condition as a profound emptiness, a sense that one simply does not care about themselves and their surroundings.

The circumstances that would normally cause us to be happy, sad, angry, interested and curious simply have no effect. The connections that drive us though our daily routines, that motivate us to perform certain tasks, are lost for the depressed. For the depressed, life becomes empty and meaningless without these connections and emotional responses.

Psychologists identify two distinct types of depression. Reactive depression is where the individual becomes depressed as a result of some emotional or physical shock to their life circumstances. The loss of a loved one or a disaster that takes one’s house can result in a profound emotional shock that leaves one unable to process life events as they normally do. This is seen as a normal response to a traumatic event in one’s life. For most individuals it is something from which they recover over time. As the shock of a traumatic event wears off the individual is able to return to normal.

The other type of depression is called clinical. With clinical depression an individual experiences a depression that may or may not be related to a specific event. The individual becomes depressed and remains in that state for an extended period of time. Understanding the difference between these two conditions is often important for stroke survivors and especially for caregivers. In the process of stroke recovery it is normal for the survivor to take time to process their post stroke condition.

They need to recognize and process the mental and physical losses associated with their stroke. These losses are often significant and, as with the loss of a loved one, represent a severe shock to the system. The reactive depression associated with these losses is normal. The recovery from these losses might be extended due to the stroke if the stroke also affects the survivor’s ability to recognize and process this information. It is important to understand that the reactive depression is a normal part of recovery.

If, however, the depression remains for an extended period of time the survivor may need to seek help. The challenge with stroke is to determine what ‘extended’ means in your particular situation. It is often up to the caregiver to understand and recognize the condition and alert the proper medical professionals of your concerns. The survivor may not be able to recognize or understand the condition themselves.

The survivor may not be willing to admit to being depressed. Treatment for depression is important as a long term depression can affect one’s health, recovery and in the most severe cases can result in suicide. A depressed survivor is not motivated to exercise, concentrate or put forth the significant effort required for recovery.

The caregiver needs to help the doctor determine if a survivor’s activity or attitude seems normal for them or if there is some significant problem in the survivor that needs to be addressed.

It is important to recognize, as well, that there are effective treatments available that help a survivor overcome depression. Depression is not just an undefined emotional response but, as research suggests, can be traced to identifiable chemical imbalances in the brain. A stroke can alter the chemistry of the brain as it deals with the loss of cells and cleans itself. A stroke might also affect the limbic system that resides within the brain.

The limbic system is a collection of cells or nuclei that excrete or distribute mood altering chemicals throughout the brain. Brain cells communicate with each other by releasing then reabsorbing a variety of chemical compounds into the microscopic spaces between the cells. For example, when a danger presents itself, it is the limbic system and its chemical messengers that alert the body, causing the fear and anxiety associated with that danger.

In normal circumstances it is the limbic system and its chemical messages that cause us to be happy, sad, anxious etc. If these cells are directly damaged by the stroke the ability to experience normal emotions can be severely impaired. If the limbic system is not directly affected the brain may be altered in more subtle ways. These changes can affect one’s ability to fully recover from the short term, reactive depression described earlier. One brain chemical, Serotonin, has been identified as important in maintaining one’s sense of well-being. A Serotonin deficiency is often associated with depression.

The good news here is that once depression is recognized it can often be successfully treated. Medications that alter brain chemistry are available. Most readers will recognize Prozac as a treatment for depression. This drug blocks the reabsorption of Serotonin in the patient’s brain cells, often increasing the patient’s sense of well-being, helping to overcome depression.

Other treatments, too numerous to detail here, are also available. It is known that each individual can react differently to these medications due to the complexity of the brain. With this in mind, it is up to the doctor to experiment with the types and doses of different ‘antidepressants in an effort to determine which medication and which dosage will be most effective for each survivor

The point here is to recognize that, in stroke survivors, some depression is normal but extended periods of depression are not. Since we all know each individual is different we need to pay attention to what depression is and how long it lasts. We need to determine if and when it is appropriate to alert your medical team of the possibility of a clinical depression and seek treatment when necessary. Depression is a mysterious condition, even in healthy individuals. It is even more of a challenge to stroke survivors but needs to be recognized and dealt with in order to promote the fullest mental and physical recovery.

Much of the information presented here is contained in an instructional CD set entitled “Understanding the Brain” available through Great Courses.
Copyright @November 2014
The Stroke Network, Inc.
P.O. Box 492 Abingdon, Maryland 21009
All rights reserved.

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