BY SARAH SONG, MD, MPH
Ellen, a vivacious woman in her 80s, experienced a stroke last year that resulted in vision loss on the left side in both eyes. Otherwise, she had regained her strength and was recovering well. However, in the course of a recent clinic visit, she told me she was feeling down. Prior to her stroke she had been an active golfer and swimmer. Since her stroke, she was often too depressed to do either.
I explained to Ellen that depression after a stroke is actually quite common, affecting about one-third of all stroke survivors, especially those who experience physical or mental difficulties. People who have a history of depression or whose social environment is problematic may also be more prone to depression after stroke. And depression isn't just a psychological response. Research suggests biological factors can contribute to mood changes, as well.
Don't Ignore Depression
I commended Ellen for sharing her feelings with me since recognizing and treating depression can improve recovery. Untreated depression can worsen quality of life and even hasten death. When patients report feelings of sadness it allows them and their doctors to discuss treatment. In Ellen's case, I encouraged her to visit the driving range with a friend to practice her golf swing, and to walk in the pool with weights or take a water aerobics class, if she didn't feel like she could swim.
For all my patients I share this additional advice.
Symptoms of depression can include feeling down, loss of appetite, a lack of interest in activities that used to bring joy, or changes in sleeping patterns, such as sleeping too much or too little. It's important to recognize and treat depression because it can influence how well you recover from stroke, physically and cognitively. The depression can also worsen your quality of life, and even hasten death.
Recognizing depression after a stroke can be difficult because some stroke symptoms can mimic depression. For example, after a stroke, some people experience reduced emotional expression or a "flat affect," which can make them seem depressed. Problems with communication such as difficulty understanding or trouble speaking can limit diagnosis and treatment of depression.
Patients with pseudobulbar affect—sudden outbursts of laughing or crying for no apparent reason—can be mislabeled as having depression. Still, it's essential for doctors to continue to check for symptoms of depression, and for families and caretakers to notice when their loved ones seem sad or depressed.
Important Ways to Manage Depression
1. Check in with yourself daily. Assess how you're feeling. Pay attention to your mood. If you're feeling down, become proactive about trying to improve your mood: Talk to a friend, or participate in an activity that brings you joy. If you're feeling good, share that good mood with others in conversation, or write it down, for a visual reminder of a happy day.
2. Educate yourself and others. Learn the symptoms of stroke—and share them with those you love. Use this opportunity to talk to others about how stroke has impacted your life. Symptoms of stroke can be easily summarized by the acronym FAST: F for face drooping, A for arm weakness or numbness, S for speech problems, such as slurred speech or difficulty finding words, and T for time, to remind you to call 911 if you see stroke symptoms in others or experience them yourself.
3. Learn the difference between anxiety and depression. The two mood disorders can occur at the same time, and make your progress in therapy more difficult. Anxiety includes feelings of worry and fear that can be disabling, and can affect everything from social interactions to participating in therapy. Anxiety must be diagnosed by a physician, as medications for depression may not be effective for anxiety, or may affect people with anxiety differently.
4. Get moving. Hormone regulation may change after a stroke, leading to an increase in cortisol levels. Elevated cortisol levels can make you feel sluggish and fatigued, cause weight gain, affect blood pressure, and lead to emotional lability. Exercise can help counter that. Studies show that even four weeks of exercise could have a beneficial effect on mood.
5. Guard your immune system. Depression can suppress your immune function, so be sure to wash your hands regularly and keep active to help boost immune function.
6. Stay socially engaged. Consider group activities, such as exercise classes, support groups, or book clubs, as a way to interact with those you love or to meet new people.
7. Consider mindfulness activities. Meditation, tai chi, yoga, or gentle stretching can help reduce stress and mental fatigue.
8. Stay in touch with your doctor. Mood disorders can arise at any time after a stroke. You should let your doctor know if you're feeling down.
9. Seek out other stroke survivors. Talking to people going through a similar experience can help allay fears. Look for a support group at supportnetwork.heart.org/home, through the American Heart Association website. Also, many local hospitals will have a support group that you can join.
10. Get treatment. Consider medication, counseling, or a combination of the two. Early treatment may have a positive effect on how well you recover from a stroke, not only emotionally, but also physically.