The current World Health Organisation definition of stroke is to rapidly develop clinical signs of focal (or global) disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin.
Features of depression
There are several reasons outlined in the genesis of post-stroke depression.
They include the location of the stroke, genetic factors, the availability of social support, and personality factors.
The sudden onset of disability may trigger an emotional response.
Brain injury and neurochemical changes may produce changes in the mood.
Post-stroke depression as a result of a stroke is strongly associated with impairment in the activities of daily life.
The individual may have a family history of depression or may have had a depressive episode prior to the stroke.
Some stroke symptoms in hospitalised patients overlap with depressive symptoms, including weight loss, fatigue, and altered sleeping patterns.
The clinician will need to look for other symptoms such as dysphoria, loss of pleasure in previously pleasurable activities (anhedonia), feelings of guilt or worthlessness, impaired concentration, inability to make decisions, and suicidal thoughts.
Speech difficulties occur in about 30% of stroke patients, posing a major challenge to an accurate diagnosis of depression in stroke patients.
A 2014 study estimated the frequency of post-stroke depression to be 31%.
In fact, while many other studies have prepared different estimates, the majority zeroes in on a prevalence of around 30%.
Gender is not a significant risk factor for post-stroke depression, although some studies have identified the sex as such.
Treatment
The treatment of post-stroke depression should ideally involve biological, psychological, social, and rehabilitation paradigms.
Such holistic and comprehensive care may not always be feasible in resource-constrained settings.
Small studies have indicated the efficacy of cognitive behavioural therapy in reducing depressive symptoms in stroke patients.
Some studies have considered novel technologies such as virtual reality and reported beneficial effects for individuals with post-stroke depression.
Behavioural activation therapy is based on prolonging the frequency of pleasant and enjoyable events, and this has shown some promising results.
Similarly, reminiscence therapy, which is routinely employed in dementia, involves recalling prominent life events and pleasurable memories to enhance belonging.
Researchers have shown that it can reduce the burden of depressive symptoms following a stroke.
Brain stimulation modalities, such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) among others, have also been shown to be effective in relieving post-stroke depression.
Way forward
Stigma and lack of awareness regarding post-stroke depression can result in patients getting over-investigated and yet being under-treated.
Evidence-based biological, psychological and social interventions delivered by psychiatrists can vastly improve the quality of life of patients.
The aphorism “prevention is better than cure” should be readily applied to stroke and post-stroke depression.
