Doctor K: Depression after stroke not uncommon

DEAR DOCTOR K: My father had a stroke and has become depressed during his long recovery. Will antidepressants help? I’m asking because of the damage the stroke has done to his brain.

DEAR READER: About one in four people who’ve had a stroke develop major depression. You’re right that the injury to the brain from the stroke can itself cause changes in brain chemistry that lead to depression. However, depression also can be a reaction to the impairments caused by the stroke. In other words, depression following a stroke can be like depression following another major illness that affects a person’s life but does not injure the brain – such as a heart attack or cancer.

You might think that in someone who has difficulty talking or understanding speech, or difficulty moving his arms and legs, depression is the least of his problems. But the mental anguish of depression isn’t a minor concern. Left untreated, depression can undermine efforts at rehabilitation and worsen cognitive disabilities.

Depression after a stroke is associated with poorer outcomes a year after the stroke has occurred. It’s also associated with a higher death rate in subsequent years.

Fortunately, antidepressants seem to be fairly effective. In 2008, scientists published a review of the research in this area. They concluded that the medications had a “small but significant” effect on post-stroke depression.

What’s more, the benefits of antidepressants may not be limited to relieving depression; they may positively affect areas and networks in the brain that improve other impaired functions as well.

Studies published in the last couple of years have found that certain antidepressants (in combination with physical therapy) can help with recovery from stroke-induced paralysis, muscle weakness and overall disability.

Talk to your father’s doctor about his depression. Ask the doctor to recommend a psychiatrist who has experience working with stroke patients, or find out if there is a mental health professional affiliated with your father’s rehab program.