Depression often comes after a stroke

The soul suffers from stroke

30/10/2013

Strokes are one of the serious diseases of the brain. For those affected, life changes from one moment to the next. He often comes without notice. A distinction can be roughly made between the sudden onset of reduced blood flow, also called cerebral infarction, and the acute cerebral hemorrhage. They are among the most common diseases and are the third leading causes of death in Germany. Fast action can enormously increase the chances of survival and rehabilitation. In addition to the great physical limitations, sufferers of stroke often suffer from a depression that accompanies the mental stress.

Often also psychological suffering
"Depression diagnosed after stroke is referred to medically as post-stroke depression (PSD)," explains Professor Matthias Endres, director of the Department of Neurology at the Charité University Hospital in Berlin. More than 30 percent of all stroke patients develop depressive symptoms that need to be treated. The doctor must be able to clearly distinguish whether those affected only suffer from a depressive mood or whether it is a true depression. Because of the serious physical injuries that can cause strokes, the follow-up exam often neglects and overlooks the psychiatric assessment so the patient suffers from PSD in addition to their physical limitations.

"Doctors must therefore be sensitized to consider the possibility of PSD in each stroke patient," said Endres, who is also chairman of the German Stroke Society, on the occasion of World Stroke Day on October 29.

This is the big challenge in this area. Doctors should recognize what the patient looks like after such a hard stroke of fate. If in doubt, it is advisable to interview relatives as well. It is not always easy to understand the extent to which a person confined to a bed or wheelchair suffers from listlessness, which then solidifies as depression.

The physical limitations of the patient often complicate a diagnosis. Often it is not possible to ask about the emotional state of mind, as speech disorders or even paralysis impede communication. "In the case of severe physical impairments, a PSD can be recognized without any doubt only with particular tact, a wealth of experience and knowledge of human nature," concludes Endres. Another complicating factor for the treating physician is that it is not clear which causes are mainly responsible for a PSD.

Thus, the lack of supply of brain cells with oxygen could well lead to mental problems. "There is evidence that lesions in certain brain areas can lead to an increase in PSD," says Endres. "As neurologists, it is particularly exciting for us to explore which biological processes in the brain can lead to which psychological effects: It is probable that PSD is not only a reactive depression, but biological changes in the brain after a stroke lead to a domino effect who can even have a long-term mental health effect, "explains Endres.

In any case, the greater the damaged brain volume after a stroke, the higher the risk of post-stroke depression. People who already suffered from depression before a stroke are even more at risk.

PSD symptoms are similar to depression
Symptoms of PSD are the same as depression. To diagnose post-stroke depression, doctors can use the diagnostic guidelines for depression. In addition to the classic symptoms such as lack of drive, loss of interest, depression, joyless, concentration and sleep disorders, adjustment difficulties can also be noticeable. "If five to six features of the ICD-10 guidelines are identified, and if these conditions persist for more than fourteen days in a stroke patient, then therapeutic treatment should be provided," concludes Endres. Diagnosing PSD can not only put the patient's life at risk, but also reduce the chances of healing and rehabilitation. This has been shown by research. It is important that patients spend a lot of time, strength and discipline on rehabilitation to minimize the damage. For more than two-thirds of all stroke patients, all efforts are in vain before beginning. You have to relearn movement and language. Anyone who gives up and happily and hopelessly thinks of an improvement, will have only limited success in rehabilitation. PSD not only reduces the already lower quality of life, but also demonstrably increases the mortality rate.

No antidepressants for prophylaxis
Stroke patients who are clearly suffering from post-stroke depression are now being treated with modern antidepressants. "The so-called tricyclic drugs commonly used in depression, however, are not used in PSD because they affect cardiac conduct and may therefore have contraindicated effects in stroke patients, who are in the vascular population," says Endres.

Due to the special situation, not every PSD is diagnosed. At the same time, at least one third of all patients are affected. For many specialists, therefore, the question arises whether antidepressants should be given as a precaution to every stroke patient. "The data is contradictory, there are studies that show no effects, but also studies that have proven beneficial effects," the neurologist continues. However, as long as no final judgment can be given, treatment with antidepressants will only be treated if there is a clear PSD diagnosis. (Fr)