Around 3% of the population in Maryland experiences a stroke every year. According to decades of research, around one-third of those stroke survivors are likely to experience post-stroke depression (PSD) within a year after a stroke, and up to half of all stroke patients may experience depression eventually. Research also has found that patients with depression after a stroke have a harder time recovering. The reasons for this link between stroke and depression are not fully known, but one thing is clear: Recognizing the signs and getting treatment for depression is essential for both stroke survivors and family members.
Why Stroke May Lead to Depression
Mental health struggles are common after major medical events, such as a heart attack or cancer treatment. And it makes sense—not only are many people forced to confront their mortality in a new way, but they may also be facing limitations on physical activity or aspects of daily life they took for granted. However, depression after a stroke is often somewhat different. While feelings of sadness or grief for one’s pre-stroke life may be part of the issue, a stroke also causes physiological changes to the brain. Researchers suspect some of these changes are likely part of the reason so many stroke survivors experience depression.
People with severe physical and cognitive problems after a stroke are at higher risk for PSD. Other risk factors include a history of depression prior to stroke and a lack of family or social support during stroke recovery. Research has found that stroke survivors who were more physically active pre-stroke were less likely to have PSD; however, they still had similar levels of anxiety.
Recognizing the Symptoms of Post-Stroke Depression
Depression after a stroke can be hard to recognize. Although the signs are similar to the normal signs of depression, the effects of the stroke may make it harder for both caregivers and patients to notice what is happening. Symptoms of post-stroke depression include:
- Changes in sleep or eating habits
- Difficulty concentrating
- Fatigue
- Feeling anxious or sad for no reason
- Feeling hopeless or like life is meaningless
- Feeling worthless or guilty
- Increased irritability
- Isolating from friends or family
- Lack of pleasure or loss of interest in things you used to enjoy
- Suicidal thoughts
If several of these symptoms are present for at least two weeks, you or your loved one may be experiencing depression. Since some of these symptoms may overlap with normal physical changes after a stroke, it’s important to discuss every symptom with your physician.
Don’t Delay Seeking Help
While rates of PSD begin to drop around 12 months after a stroke, some patients will still experience depression within the next few years. Multiple studies have found that not getting treatment for depression in addition to stroke worsens both physical and mental health outcomes. Patients with PSD are also at higher risk for a second stroke.
There is ongoing research as to whether it is possible to prevent depression from occurring after a stroke. So far, no definitive solutions have been found. However, you should discuss PSD with your or your family member’s provider after a stroke, especially if there are risk factors such as a prior history of depression. Being prepared and knowing what to watch for can help ensure the depression is treated at the onset and the symptoms are not missed for months.
Caregivers Are at Risk, Too
Caregiving after a stroke isn’t easy. But taking care of a stroke patient who is also experiencing PSD may be even harder. One study found that caregivers were more likely to develop depression themselves in the first two years after caring for someone with both a stroke and depression. While every patient and every caregiver’s situation may be slightly different, the study is a reminder that getting treatment for PSD affects more than one person. Caregivers may also find support groups helpful during this stressful time.
Could Depression Be a Risk Factor for Stroke?
There may be another link between depression and stroke beyond PSD. Recent research looking at 26,877 first-stroke patients in 32 countries found that people with symptoms of depression prior had a greater chance of having an acute stroke. This risk held steady even after adjusting for other factors that increase risk, such as diabetes, hypertension, weight and stress. These patients were also more likely to have worse outcomes in early recovery from a stroke.
Intriguingly, patients with depression who were receiving treatment, such as antidepressants, did not have an increased risk. While it’s too soon to comprehensively state that depression should be considered a risk factor for stroke, it’s one more good reason to get prompt treatment if you know you could be at risk for a stroke.
Stroke and Depression Care
Just as stroke care has improved dramatically in recent years, depression now has a wider range of treatment options. Some patients may benefit from talk therapy, such as cognitive behavioral therapy (CBT). Others may find antidepressant medication, in combination with therapy or alone, helps in treating depression. Newer modalities, such as transcranial magnetic stimulation, may also be helpful, and clinical trials are underway investigating ketamine as a treatment for PSD. The University of Maryland Medical System can help you or your loved one navigate post-stroke depression treatment options that work with your stroke recovery care.
If you have thoughts of harming yourself, it is very important to seek help immediately. Please call 9-8-8 for mental health support or 9-1-1 for emergency care.
More to Read
- Suicide Prevention: How to Recognize Red Flags—and Where to Reach Out for Help
- Stroke 101: How to Identify and Prevent Stroke
- How to Recover After a Stroke
- Ischemic Stroke: How You Can Avoid One
Medically reviewed by Shellee Stine BSN, RN, FNE A/P, SCRN.
