Depression hits half of stroke patients
Half of all stroke survivors will suffer depression, which could seriously impede their recovery and rehabilitation. Physicians and families have to be alert for the signs of depression, be aware that it is common and help patients realize it is part of the disease process, said Dr. Tanya Warwick, medical director of UCSF Fresno Stroke Center at Community Regional Medical Center.
Dr. Warwick, a board certified vascular neurologist and assistant clinical professor of neurology, lectured about post-stroke depression on July 26 to UCSF Fresno residents and Community’s clinical staff.
Three-quarters of a million Americans suffer strokes annually. It’s the third leading cause of death and the leading neurological cause of permanent disability. Nearly 80% of stroke patients survive and half of them will become depressed within the first year after their stroke – the most crucial period for recovery, Dr. Warwick said.
Depression after a stroke is not just the moody blues and can’t be brushed off, warns Dr. Warwick. Stroke patients with depression, she says, will often socially isolate themselves, fail to participate in their rehabilitation and be unmotivated to try to get better.
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| Dr. Tanya Warwick |
Several studies have shown that those most at risk for developing depression after a stroke are younger, have suffered paralysis or more severe disability, have few social supports, have vision loss, experience speech or language difficulties and/or have temporal or frontal lobe lesions.
Dr. Warwick said she often can spot patients who are likely to develop depression. Patients who are aphasic, or having significant problems speaking and/or understanding language, have a much harder time dealing with the affects of their brain attack.
“I’ll prophylactically treat them with anti-depressants,” she said, pointing to two 2007 medical studies. One showed that treating depression helps patients recover their physical and mental functions faster and another suggested that giving antidepressants before depression surfaces, significantly reduces its occurrence among stroke patients.
Dr. Warwick said although no studies have been done on cultural differences, she has found that her Hmong and Hispanic patients have particular difficulties adjusting to losing their status as the head of the family or as the family caretaker. While men’s depression more often exhibits itself as extreme fatigue and lack of motivation, women are more likely to suffer anxiety, she said.
“And cosmetic issues are really important to women,” Dr. Warwick said. “I get mushy with my patients. I’ll tell them ‘Yes you have a little facial droop, but you’re still beautiful.’ Then I take husbands aside tell them they have to constantly be reassuring. If there are daughters in the house, I’ll tell them ‘Make sure your mom is getting her hair done regularly and attending to personal grooming. Don’t let mom lay around the house all day in her funky robe.’”
Dr. Warwick suggests physicians be frank and honest with patients about what to expect after a stroke. Don’t promise full recovery of function, but let people know to “give it a year” and be patient. She also asks families and patients to be alert and let her know if they are experiencing any of the following signs of depression:
- Low mood
- Guilt
- Suicidal ideations
- Insomnia
- Fatigue
- Loss of sexual drive
- Anorexia
- Irritability
- Anxiety
- Inability to feel pleasure
- Poor attention
- Difficulty with memory
- Negative thinking
- Poor motivation
She also makes sure patients and their families understand that depression not only affects moods and thoughts, but can affect the body and the way people eat or sleep. It’s not a sign of personal weakness and it can’t be willed or wished away, she stresses.
“Depression is easily treated and it doesn’t mean they’ll be on medications forever,” Dr. Warwick said.
This story was reported by Erin Kennedy. She can be reached at ekennedy@communitymedical.org.