Provided by the National Institute of Mental Health
Symptoms of Depression
Persistent sad, anxious, or "empty" mood
Feelings of hopelessness, pessimism
Feelings of guilt, worthlessness, helplessness
Loss of interest or pleasure in hobbies and activities that were once enjoyed,
including sex
Decreased energy, fatigue, being "slowed down"
Difficulty concentrating, remembering, making decisions
Insomnia, early-morning awakening, or oversleeping
Appetite and/or weight changes
Thoughts of death or suicide, or suicide attempts
Restlessness, irritability
If five or more of these symptoms are present every day for at least two weeks
and interfere with routine daily activities such as work, self-care, and
childcare or social life, seek an evaluation for depression.
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Introduction
Depression can strike anyone, but people with serious illnesses such as stroke
may be at greater risk. Appropriate diagnosis and treatment of depression may
bring substantial benefits to persons recovering from a stroke by improving
their medical status, enhancing their quality of life, and reducing their pain
and disability. Treatment for depression also can shorten the rehabilitation
process, lead to more rapid recovery and resumption of routine, and save health
care costs (e.g., eliminate nursing home expenses).
Stroke can occur in all age groups and can happen even to fetuses still in the
womb; but three-fourths of strokes occur in people 65 years of age and over,
making stroke a leading cause of disability in older persons. Of the 600,000
American men and women who experience a first or recurrent stroke each year,1 an
estimated 10 to 27 percent experience major depression.2 An additional 15 to 40
percent experience some symptoms of depression within 2 months following a
stroke.2
The average duration of major depression in people who have suffered a stroke is
just under a year. Among the factors that affect the likelihood and severity of
depression following a stroke are the location of the brain lesion, previous or
family history of depression, and pre-stroke social functioning. Stroke
survivors who are also depressed, particularly those with major depressive
disorder, may be less compliant with rehabilitation, more irritable, and may
experience personality change.2
Despite the enormous advances in brain research in the past 20 years, depression
often goes undiagnosed and untreated. Stroke survivors, their family members and
friends, and even their physicians may misinterpret depressive symptoms as an
inevitable reaction to the effects of a stroke. But depression is a separate
illness that can and should be treated, even when a person is undergoing
post-stroke rehabilitation. Although depressive symptoms may overlap with
post-stroke symptoms, skilled health professionals will recognize the symptoms
of depression and inquire about their duration and severity, diagnose the
disorder, and suggest appropriate treatment.
Depression Facts
Depression is a serious medical condition that affects thoughts, feelings, and
the ability to function in everyday life. Depression can occur at any age. NIMH-sponsored
studies estimate that 6 percent of 9- to 17-year-olds in the U.S. and almost 10
percent of American adults, or about 19 million people age 18 and older,
experience some form of depression every year.3,4 Although available therapies
alleviate symptoms in over 80 percent of those treated, less than half of people
with depression get the help they need.4,5
Depression results from abnormal functioning of the brain. The causes of
depression are currently a matter of intense research. An interaction between
genetic predisposition and life history appear to determine a person's level of
risk. Episodes of depression may then be triggered by stress, difficult life
events, side effects of medications, or other environmental factors. Whatever
its origins, depression can limit the energy needed to keep focused on treatment
for other disorders, such as a stroke.
Stroke Facts
A stroke occurs when the blood supply to part of the brain is suddenly
interrupted or when a blood vessel in the brain bursts, spilling blood into the
spaces surrounding brain cells. Symptoms of stroke appear suddenly and often
there is more than one symptom at the same time:
Sudden numbness or weakness of the face, arm, or leg, especially on one side of
the body
Sudden confusion, trouble talking, or understanding speech
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, or loss of balance or coordination
Sudden severe headache with no known cause
The most important risk factors for stroke are hypertension, heart disease,
diabetes, and cigarette smoking. Others include heavy alcohol consumption, high
blood cholesterol levels, illicit drug use, and genetic or congenital
conditions, particularly vascular abnormalities.
Gender also plays a role in risk for stroke. Men have a higher risk for stroke,
but since men do not live as long as women, women are generally older when they
have strokes and are more likely to die from them. However, women's hormonal
changes during pregnancy, childbirth, and menopause increase their risk for
stroke. The risk of stroke associated with pregnancy is greatest in the
postpartum period—the 6 weeks following childbirth. Risk for stroke also varies
among different ethnic and racial groups.
Although stroke is a disease of the brain, it can affect the entire body. Some
of the disabilities that can result from a stroke include paralysis, cognitive
deficits, speech problems, emotional difficulties, fatigue, and daily living
problems. Many people require psychological or psychiatric help after a stroke.
Depression, anxiety, frustration and anger are common post-stroke disabilities.
Because stroke survivors often have complex rehabilitation needs, progress and
recovery are unique for each person. Although a majority of functional abilities
may be restored soon after a stroke, recovery is an ongoing process.
Get Treatment for Depression
Depression can affect mind, mood, body, and behavior. While there are many
different treatments for depression, they must be carefully chosen by a trained
professional based on the circumstances of the person and family. Prescription
antidepressant medications are generally well-tolerated and safe for people
recovering from a stroke. There are, however, possible interactions among some
medications and side effects that require careful monitoring. Therefore, stroke
survivors who develop depression, as well as people in treatment for depression
who subsequently suffer a stroke, should make sure to tell any physician they
visit about the full range of medications they are taking.
Specific types of psychotherapy, or "talk" therapy, also can relieve depression.
Sometimes it is beneficial for family members of a stroke survivor to seek
counseling as well.
Treatment for depression in stroke survivors should be managed by a mental
health professional—for example, a psychiatrist, psychologist, or clinical
social worker—who is in close communication with the physician providing the
post-stroke rehabilitation and treatment. This is especially important when
antidepressant medication is prescribed, so that potentially harmful drug
interactions can be avoided. In some cases, a mental health professional that
specializes in treating individuals with depression and co-occurring physical
illnesses such as stroke may be available.
Recovery from depression takes time. Antidepressant medications can take several
weeks to work and may need to be combined with ongoing psychotherapy. Not
everyone responds to treatment in the same way. Prescriptions and dosing may
need to be adjusted. No matter how severe a stroke, however, the person does not
have to suffer from depression. Treatment can be effective.
Use of herbal supplements of any kind should be discussed with a physician
before they are tried. Recently, scientists have discovered that St. John's wort,
an herbal remedy sold over-the-counter and promoted as a treatment for mild
depression, can have harmful interactions with some other medications.
Remember, depression is a treatable disorder of the brain. Depression can be
treated in addition to whatever other illnesses a person might have, including
stroke. If you think you may be depressed or know someone who is, don't lose
hope. Seek help for depression.
For more information about depression and research on mental disorders
Please visit the following links for more information about organizations that
focus on depression and other illnesses and research on mental disorders.
References
1Know stroke. Know the signs. Act in time. National Institute of Neurological
Disorders and Stroke, 2001. http://www.ninds.nih.gov/health_and_medical/pubs/knowstroke.htm
2Depression Guideline Panel. Clinical practice guideline, number 5. Depression
in primary care: volume 1. Detection and diagnosis. AHCPR Pub. No. 93-0551.
Rockville, MD: U.S. Department of Health and Human Services, Agency for Health
Care Policy and Research, 1993.
3Shaffer D, Fisher P, Dulcan MK, et al. The NIMH Diagnostic Interview Schedule
for Children Version 2.3 (DISC-2.3): description, acceptability, prevalence
rates, and performance in the MECA Study. Methods for the Epidemiology of Child
and Adolescent Mental Disorders Study. Journal of the American Academy of Child
and Adolescent Psychiatry, 1996; 35(7): 865-77.
4Regier DA, Narrow WE, Rae DS, et al. The de facto mental and addictive
disorders service system. Epidemiologic Catchment Area prospective 1-year
prevalence rates of disorders and services. Archives of General Psychiatry,
1993; 50(2): 85-94.
5National Advisory Mental Health Council. Health care reform for Americans with
severe mental illnesses. American Journal of Psychiatry, 1993; 150(10): 1447-65.
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All material in this brochure is in the public domain and may be reproduced or
copied without permission from the Institute. Citation of the National Institute
of Mental Health as the source is appreciated.
NIH Publication No. 02-5006
Department of Health and Human Services
Public Health Service
National Institutes of Health
National Institute of Mental Health
May 2002
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