Stroke and Depression

By , Caring.com senior editor
A stroke can trigger depression.

For most people, the word “stroke” brings to mind a constellation of problems, including paralysis and difficulty with speech. But if someone has recently had a stroke, you’re probably well aware that the effects go well beyond the physical. The emotional aftermath can be just as overwhelming and far more difficult to sort out.

Although depression can strike anyone, those who’ve suffered a catastrophic illness may be more susceptible than other people. And when you throw a brain injury into the mix, the risk of developing a mood disorder becomes even greater. As many as half of stroke survivors will become depressed, according to James Castle, a neurologist at Stanford University.

Depression isn’t just miserable, it may also make a stoke survivor more susceptible to pain and fatigue and may even delay his recovery.

  • In a study published in the journal   Stroke,   researchers reported that stroke survivors who were treated for depression demonstrated improved recovery in regular daily activities compared with those whose depression went untreated.
  • People who are depressed also tend to be less compliant with rehabilitation and more resistant to making lifestyle changes to prevent a second stroke.

Fortunately, depression can be treated. With the appropriate care, a patient will lead a happier life — and life will be easier for you, too. Here are some practical things you can do if you think the person you’re caring for is depressed after a stroke.

Be alert to warning signs of depression after a stroke

It’s not always easy to recognize depression. In the case of someone who’s had a stroke, the situation can be even more complicated. If a patient has trouble talking or understanding language, it might be especially difficult to recognize depression. Increased   emotional liability   — sudden and extreme mood swings, common after a stroke — may also hide symptoms of depression.

You may also think he has good reason to feel depressed. After all, he’s just had a stroke and can’t do the things he used to be able to do. But there’s a difference between the normal   grieving   process and depression. The warning signs of depression include:

  • Frequent crying episodes
  • Feelings of hopelessness or worthlessness
  • Poor appetite or increased appetite
  • Sleeping too much or not enough
  • Increased agitation and restlessness
  • Loss of interest in life
  • Expressing thoughts of dying or suicide

A stroke survivor should be evaluated for depression if he has had several of these symptoms for more than two weeks.

Encourage a stroke survivor to be tested for depression

If you believe a patient is depressed, the first step is to talk to him about his feelings. This isn’t always easy, especially if he isn’t used to expressing emotions. Ask him if he’s feeling sad or hopeless. Try to get an idea if it’s really depression or just a temporary case of the blues.

The next step is to schedule an evaluation. His primary care physician may want to talk to him first, or she may refer him to a psychiatrist or counselor. In any case, the evaluating doctor will talk to him and assess his mood. She may also order screening tests to rule out other medical conditions that can mimic depression, such as a thyroid disorder or infection.

If he resists the idea of testing because he’s embarrassed or afraid, help him understand that a diagnosis of depression isn’t the shameful secret it once may have been. It doesn’t mean he’s “crazy” or is going to be taken away to a   nursing home   . And his test results are private, so no one b ut he and his doctor needs to know.

If he absolutely refuses to see a doctor, there’s not a whole lot you can do. “There’s no way to force the issue unless there are severe circumstances,” says Castle. If he has become psychotic or suicidal, or if his depression has progressed to the point where he can no longer care for himself, Castle recommends that you notify his doctor or emergency medical services immediately. Otherwise, your best bet is to enlist family members and friends to try to persuade him to seek help.

Support a stroke survivor during treatment for depression

If a patient is diagnosed with depression, the doctor may prescribe antidepressant medications and/or recommend psychotherapy. “Most doctors take a multidirected approach toward battling depression,” says Castle. “Medicines can be highly effective, but often there’s a role for psychotherapy and lifestyle changes.”

Even if a primary care doctor diagnosed depression, a patient may still benefit from seeing a mental health professional, says Castle. “Some primary care physicians feel comfortable treating this disorder, but many would prefer the assistance of a psychiatrist or psychologist.” Castle says this can be difficult for people who associate a stigma with mental health treatment. “It’s important for the family to support the patient over that barrier.”

The person in your care may also be nervous about taking antidepressants, but Castle points out that they present very little risk: “If anything, there’s some evidence to suggest that these medicines might actually decrease the chance of having another stroke.” Some of the common side effects, such as loss of libido or excessive sweating, can be annoying, but they’re nothing compared to the misery of depression. And the doctor can work with the patient to find the most effective medication with the fewest side effects.

Other ways you can help a stroke survivor with depression

Simply supporting the patient as he struggles with depression can help him a great deal. Here are some other things you can do:

  • Help him stay as physically active as possible.   Talk to the doctor and rehabilitation team about what exercises are appropriate. Find activities you can do together, such as a morning walk around the neighborhood.
  • Depressed people often want to sleep during the day.   “As much as possible, don’t allow a patient to slip into a depressed routine,” says Castle. “Break the cycle by encouraging him to be awake during the day with exposure to sunlight.” A simple walk outdoors or some time in the garden can really help.
  • Structure the day around activities that give him pleasure and a sense of purpose.   For example, meet friends for lunch or enjoy a leisurely walk through the mall.
  • Try to stay positive and upbeat, but don’t foster unrealistic expectations.   Instead of saying, “You’ll be hiking again in no time,” you might say, “If we keep walking together every day, you’ll notice that it gets a lot easier.”
  • Join a support group — for either or both of you.   Talking to other people who’re struggling with similar issues can be enormously comforting and helpful. It’s also a great way to connect with other stroke survivors and caregivers . Remember that it’s not all up to you

In the end, it’s really up to the stroke survivor to get help for depression. If he won’t talk to his doctor or comply with treatment, you can’t make him — and you shouldn’t blame yourself. Keep offering support and provide positive reinforcement when he takes those difficult steps toward recovery.

But there’s only so much you can do. If feelings of guilt and sadness overwhelm you, you may need help coming to terms with the fact that he isn’t going to get help. Ask his doctor for information about support groups and other resources to help you manage your own feelings.

Source:       E. Chemerinski et al. “Improved recovery in activities of daily living associated with remission of post stroke depression.”   Stroke   32, 2001. 

8 Ways to Get Your Memory Back After Stroke

 

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While drugs won’t help reverse memory loss after a stroke, activities, therapy and rehabilition can. Feeding your brain with mind games and a healthy diet can help with memory after a stroke.

Some degree of memory loss affects about a third of people who survive a stroke, according to the National Stroke Association. But it’s good to know there are things you can do to help get your memory back.

“Memory deficits after a stroke can vary,” says Melissa (Muller) Meyers, OTD, an occupational therapist at MossRehab in Philadelphia. The extent of your memory loss can depend on how old you are, the severity of your stroke, where your stroke occurred, and even the support you have from family and friends.

No medication is known to help reverse memory loss after a stroke, Meyers says. But where drugs won’t help, you can take steps with activities, therapy, and rehabilitation to help recover your memory after stroke.  

How to Regain Your Memory After Stroke

1. Stimulate your brain. “Games that require you to use your brain, whether as simple as checkers or complex as chess, can help you regain your memory,” says Allen Kaisler-Meza, MD, medical director of the Good Samaritan Hospital Independent Rehabilitation Program in San Jose, California.

2. Work with rehab specialists. Speech-language therapy enhances recovery. It helps by stimulating the brain to make neural connections from uninjured parts of the brain to those parts affected by stroke, Dr. Kaisler-Meza says.

Bob Mandell, now 71, who had a hemorrhagic stroke in 1996, credits various types of therapy, including speech therapy, with getting his memory back. Right after his stroke, Mandell of Naples, Florida, couldn’t get three words out and his memory loss was frustrating. But his determination to recover worked in his favor, and he believes others can do the same. “I worked really hard at therapy,” he says. He wrote about his recovery in the book Stroke Victor. “I did what psychologists called engaged therapy. I went all in, and that jarred my memory and my mind.”

3. Post reminders for yourself. Leave notes in key areas, such as a sign in the bathroom reminding you to brush your teeth, says Stephen Page, OTR/L, PhD, an occupational therapist and associate professor at the School of Health and Rehabilitation Sciences at The Ohio State University College of Medicine in Columbus. Use the alarm on your smartphone or even an old-school clock to remind yourself of appointments and when to take your medications, Page adds. Once you form a routine, it will help you re-establish your memory. Meyers agrees that in her work with patients as a therapist, “creating a routine that is repetitive and consistent can help.”

4. Make up mnemonics. Mnemonics are creative ways to remember things. They often take the form of an acronym, like the popular RICE: rest, ice, compression, and elevation — a shortcut to remember how to treat a sprain. You might make up your own mnemonic for the steps to cook a familiar meal, Page suggests. Rhymes also work, that associate a name with an object, like: “Shirley is the woman with curly hair.”

5. Get organized. Making it easy to see items you need for daily activities will help you remember what you need to do and when to do it, Meyers says. For example, lay out your clothes for the morning before you go to bed at night. Put your toothbrush on the sink where you’re sure to see it.

6. Repeat and rehearse. When you’re given new information, repeat it to yourself several times, the American Stroke Association recommends. Go over the material as many times as you need for it to sink in. Don’t be afraid to repeat back, in your own words, what you’re told to be sure you understand it correctly. If you have to make a presentation or give a speech, break up the material into smaller segments. These will be easier to remember.

7. Stay active. Get out of bed and move as much as possible, Kaisler-Meza says. A six-month exercise training program for patients promoted not only memory but also attention and conflict resolution in a small study of stroke survivors. And aerobic exercise promotes the recovery of brain function after a stroke, according to a study done on animals and published in the International Neurourology Journal.

Mandell, who was paralyzed on his right side after his stroke, believes exercise helped him regain his memory. “I always feel better after exercising,” he says. Exercise helps relieve stress and stress relief is important to brain health, he adds, noting that he tries to exercise almost every day.

RELATED: The Best Diet to Prevent Stroke

8. Feed your brain. A brain-healthy diet includes lots of fresh fruits and vegetables and fish rich in omega-3 fatty acids, according to the American Stroke Association. Eating this way will help your brain recover optimally, Kaisler-Meza says.

A healthy diet and smaller portions helped Mandell lose the 30 pounds of excess weight he was carrying when he had his stroke. He believes that helped his mental recovery. He felt better, and feeling better improved his mental outlook.

I AM important!!!


This appeared on the National Stroke Association site last week.  Check it out!

Gordon V.

I am … A Survivor

I was a family man trying to do things right — work hard, provide for my family, follow Christian values.  Yet on my 51st birthday, I suffered a massive stroke that nearly killed me and left me with serious impairments.  I went from being a healthy, active, no-risk-factor man to being half paralyzed, unable to speak, organize my thoughts, or remember.

The experience has been a true test of faith and perseverance.  My wife Jill, and I have worked together in my recovery, facing each obstacle as a challenge to be overcome.  Nothing has come back quickly or easily, but we continue to work as a team and hope for the best.

We are now 7 years post-stroke and have surpassed all expectations given with the severity of my stroke.  I am certainly not fully recovered so mine is not an “I did it and you can too” story.  My journey of recovery is still in progress and will likely be a lifetime pursuit.

Everyone needs encouragement and perspective from time-to-time. We now speak publicly about our stroke and recovery experience and how it has affected our lives, our marriage, our kids, and our faith. My hope is to inspire people and help them see that good things can happen, even when it doesn’t seem possible.  Even more importantly, I hope people will see how the Good Lord has been faithful to His word, providing for us and carrying us when we were too devastated to carry ourselves.

Jill Viggiano

Being married to an entrepreneur is a rollercoaster ride of extreme highs and lows but my husband Gordon’s stroke was a low I could not have imagined.  Pre-stroke, he had been so sharp and competent.  In a moment, he had become severely disabled, childlike, and disconnected from reality.  He had no idea how bad he was and for him, that was probably a blessing.  His entrepreneurial drive and determination were still intact and he never even considered not recovering fully.

I, on the other hand, understood fully the magnitude of his brain injury and I could imagine what our future might look like.  It was a lonely place to be:  I couldn’t cry and lament in front of Gordon or the kids.  Gordon needed to believe everything was ok—he needed that positive attitude.  The kids needed me to reassure them and to make them feel as safe as possible.  They were dealing with huge changes to their lives too.  I had to be the grown-up.

The sadness and loss stayed with me for probably 4 years.  Gordon tried very hard to go back to work as a consultant but he couldn’t do anything without me, so I became a consultant with him.  For 2 years he tried to be a consultant again and I had to watch him be unable to even form sentences in front of what Gordon believed were potential clients.  His optimism and belief that he could do it all again was essential to ongoing recovery so I couldn’t bring him down.  I had to submit to his needs, even though it was painful.

My turning point came when I embraced my powerlessness and asked God to lead me each day.  Surrendering my desperate attempts to be in control freed me of the stress and worry that weighed on me.  Each day became a gift—still difficult but gratitude began to tip the scale in my favor.

As we continue to fight the good fight for recovery, we speak to audiences about our journey and inspire them to face adversity with hope and faith.  My experiences as caregiver, wife, and mother are chronicled in my book called “Painful Blessing.”

I wrote the book for several reasons:

  1.  There is still hope, love, and joy to be had, even after a life-changing experience.
  2. There have been no shortcuts in recovery.  We are still working on it 7 years later.
  3. We cannot be the only people to go through such a devastating experience, even though it sure felt that way.

Our story is compelling, inspiring, and ongoing–all things I hope will help others in crisis.

Painful Blessing Link: https://www.createspace.com/4735394