Depression after a stroke can be successfully treated
Q: My mother had a stroke that weakened one side of her body. But the bigger problem right now is her depression. Can that be treated, or is it caused by irreversible brain damage from the stroke?
A: Strokes can cause significant problems. People can have difficulty moving (like your mother). They can have trouble speaking or understanding speech. They can have trouble thinking. Being suddenly hit with any or all of those losses would depress anyone - including people who never suffered from depression before.
About one in four people who've had a stroke develop major depression. In part, this is a reaction to the terrible losses caused by a stroke. But you're right that the injury to the brain from the stroke can itself cause changes in brain chemistry that lead to depression.
In other words, depression following a stroke can be similar to depression following another major illness that affects a person's life but does not injure the brain - such as a heart attack or cancer. But it also can be caused by the brain injury itself.
You might think that in someone who has difficulty talking or understanding speech, or difficulty moving her arms and legs, depression is the least of her problems. But the mental anguish of depression isn't a minor concern.
Left untreated, depression can undermine efforts at rehabilitation and worsen cognitive disabilities.
Depression after a stroke is associated with poorer outcomes a year after the stroke has occurred. It's also associated with a higher death rate in subsequent years.
Fortunately, antidepressants seem to be fairly effective. In 2008, scientists published a review of the research in this area. They concluded that the medications had a "small but significant" effect on post-stroke depression.
What's more, the benefits of antidepressants may not be limited to relieving depression; they may positively affect areas and networks in the brain that improve other impaired functions as well. Studies have found that certain antidepressants, in combination with physical therapy, can help with recovery from stroke-induced paralysis, muscle weakness and overall disability.
If you haven't already done so, talk to your mother's doctor about her depression. Ask the doctor to recommend a psychiatrist who has experience working with stroke patients, or find out if there is a mental health professional affiliated with your mother's rehab program.
Treatment of stroke has improved greatly in this country. Some people who would have died or been severely disabled can now do quite well. That's due, in part, to powerful drugs that can quickly open blocked blood vessels in the brain.
More recently, stents that grasp and remove the blood clots that are blocking blood flow to the brain have been found to be effective. They more than double the chance that a patient with a stroke will become functionally independent.
Doctors who concentrate on deploying all of these new treatments available for patients with stroke can sometimes neglect to recognize and treat depression. If you think that might be happening with your mother, raise that issue with her doctor.
• Dr. Anthony Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.