Depression After Stroke Is Treatable, Study Finds Treatment May Improve Thinking, Memory, and Speech

BACK

By Elaine Zablocki
WebMD Medical News

A person who has a stroke wakes up in a new world. Abilities he or she has always taken for granted are lost. Some will be regained in time; some are gone forever. It's easy to feel that if you're depressed after a stroke, it's only
natural. And there's not too much you can do about it, right?

Wrong, say researchers from Iowa and Tokyo who've been studying the effects
of treatment on post-stroke depression. People who experience depression after a stroke should see a doctor for a thorough evaluation, they say. In many cases, an antidepressant medication will lighten their mood. There could be other benefits, too: When they do recover from depression, their families can expect to see improvements such as an increased ability to speak, remember facts, and pay attention to what's going on.

How can you tell if someone has serious depression? They feel despondent and
hopeless, says Richard Zorowitz, MD. Their movements slow down. They avoid
activities they used to enjoy. They eat less. They may have trouble sleeping,
or sleep all the time. Zorowitz is an assistant professor of rehabilitation medicine at the University of Pennsylvania and medical director of the Piersol Rehabilitation Unit at the University of Pennsylvania Medical Center in Philadelphia. He was not involved in the current study.

When family members suspect someone who has had a stroke is experiencing
serious depression, they should arrange for an evaluation by a doctor with a
special interest in this subject. It may be a primary care physician, a neurologist, a psychiatrist, or a neuropsychiatrist, says Robert Robinson, MD, one of the study's authors. Robinson is head of the psychiatry department and the Paul Penning Roth professor of psychiatry at the University of Iowa.

"[This] is the first time someone has demonstrated that in patients who have a major depression following stroke, treating depression has a significant positive effect on mental functioning," Robinson says. He believes those who are treated for depression will probably experience improved movement skills, too; the research team has a study under way on this subject.

In this study, published in Stroke: Journal of the American Heart Association, researchers looked at 47 patients who were experiencing depression after a stroke. The patients were treated either with an antidepressant called nortriptyline (also known as Pamelor or Aventyl) or with inactive sugar pills over a six- to 12-week period. During the treatment period, their mental state and ability to function intellectually were evaluated using standard tests.

A little more than three-quarters of those who received the antidepressant, and just under a third of those who received the sugar pills, were no longer depressed by the time the study ended. Their mental abilities, including language, memory, and hand-eye coordination, showed a distinct improvement. "This is an important finding, particularly since depression is one of the most underdiagnosed and undertreated complications after stroke," says Zorowitz.

"This research emphasizes how important it is for consumers to request an
evaluation for depression when family members have a stroke," says Mary Jane
England, MD, who reviewed the study for WebMD. "There is evidence that
people do experience depression after stroke, and also after other major injuries
and insults to the body, such as heart surgery. Early detection and treatment
is so important, because if depression is identified, it can be treated successfully." England, a psychiatrist, is president of the Washington Business Group on Health and serves on the advisory council of the National Institute of Mental Health.

"Both the stroke patient and the care provider need to understand that this depression is often a physical consequence of the stroke, not just due to the
patient's emotional concerns," says Edgar Kenton, MD. "Emotional problems
tend to get put on the back burner. When you understand this depression is
due to a physical injury, that emphasizes that depression and mental functioning in stroke patients can and do get better." Kenton is professor of clinical neurology at the Thomas Jefferson University School of Medicine in Philadelphia and chair of the advisory committee of the American Stroke Association.

But for many patients with post-stroke depression, some form of talking therapy can be very helpful, in addition to medication, says Zorowitz. Individual therapy offers the patient an appropriate setting to vent emotions. Group therapy can be even more useful, because it shows patients they are not alone in their particular situation.