Depression is extremely common in people who have had a stroke – it is probably the most common psychological effect after stroke. In fact, it is estimated that around half of those who survive a stroke suffer significant depression within the first year. Depression after stroke can affect anyone regardless of their age, sex, background, or the severity of their stroke. It can develop immediately after the stroke happens, or weeks or months later. Many people are not routinely assessed for depression after stroke, and only a minority are properly diagnosed and treated. Being assessed and receiving the right help is crucial as managing depression can really make a difference.
What causes depression?
Having a stroke can be a frightening experience. Stroke happens very suddenly and it can take some time to come to terms with the shock of what has happened. Many people feel frightened, anxious, frustrated or angry about what has happened to them. These feelings are normal and usually fade over time, but in some people they develop into depression. Depression often sets in once the initial period of recovery is over, and the person becomes aware of how their lasting disability may affect their everyday life. The person who has had a stroke may have to come to terms with the loss of many of their hopes and plans for the future, as well as having to adapt to a changed role in the family, and possibly the loss of a career. As many of us value ourselves through everyday activities, the impact of a stroke can result in loss of confidence and lowered feelings of self-worth. Sometimes the stroke directly damages the part of the brain which generates and controls how we think, feel and behave. It may also be the result of the emotional impact of suffering a serious illness. There can also be underlying physical causes for the depression. For example, chronic pain affects many people after a stroke and is a common cause of depression. Being isolated can cause low mood, so having somebody to talk to is important in reducing the likelihood of depression.
What are the symptoms of depression?
There are a number of symptoms of depression to be aware of. The most common include:
- Feeling sad, blue or down in the dumps
- A loss of interest in every day activities
- Feelings of worthlessness, hopelessness or despair
- Inability to concentrate or difficulty making decisions
- Anxiety or worry
- Changes in sleeping pattern or appetite
- Loss of energy
- Suicidal feelings
- Low self esteem
Depression after stroke can range from mild to severe and last for anything from a few months to more than a year. The most obvious symptom is low mood, although occasionally symptoms such as anxiety or irritability are prominent. Sometimes the emotional symptom is better described as a sort of flatness or inability to feel pleasure. Depression can also cause changes in thinking, such as trouble concentrating or memory difficulties. Sometimes this negative thinking becomes severe, and the person may develop feelings of guilt or suicidal thoughts.
What are the treatments for depression?
If you are concerned that you or someone you know is depressed, do not be afraid to talk about it and mention any symptoms to the doctor. Depression is best treated when it is diagnosed and treated early. The most effective treatment is psychological intervention or counselling, combined, if appropriate, with antidepressant medication. There are also a number of things you can do yourself to help ease depression.