> After a Stroke
Depression is a generic term that covers a number of different situations
where the common factor is the feeling of depression or a state
of depressed mood. After a Stroke, depression may occur but the
situations in which it arises will lead to different types of treatment
needs. Depression as an illness is common in the general community
and the incidence of it is increasing with time. There are many
reasons why a person may get depressed and almost as many ways to
treat it. The two common terms used to describe depression after
Stroke are major depression and reactive depression.
MAJOR DEPRESSION
This is a formal clinical diagnosis that may be made be a psychiatrist/
psychologist or general practitioner. In a major depression there
is a state of low mood or a loss of enjoyment of day-to-day activities.
Sleep may be disturbed with a characteristic pattern of waking in
the early hours of the morning and not being able to return to sleep.
Appetite is poor and weight loss common. Constipation, a sense of
physical slowing, social withdrawal and a loss of sexual interest
are the classical symptoms. Suicidal ideas, feeling of guilt and
worthlessness are also described.
The person may have a past history of depression or a family history
of depression. It is possible especially if the Stroke has been
on the right side of the brain that the person will then develop
a depressive illness with these risk factors. Having a Stroke in
the left front part of the brain is a risk factor for the development
of depression regardless of a past or family history. One in four
people will after a Stroke develop a major depression. The importance
in recognizing the condition is that is can be treated. In those
people who have a Stroke and become depressed, failure to treat
results is a less than optimal rehabilitation outcome.
The management of a major depression will involve the use of medication.
These antidepressants are used to correct the chemical imbalance
that has been precipitated by the depression. Treatment will usually
only involve one medication and will probably need to be for 6 to
12 months. In combination with the antidepressants, cognitive therapy
should also be incorporated into the treatment plan. This is a talking
therapy that helps a person look at how their thinking style may
be unhelpful and therefore maintain the depression. Usually ten
sessions are allocated to help a person with depression. Obviously
this therapy may have to be modified if the Stroke has affected
the communication areas.
REACTIVE DEPRESSION
This is a term used to describe a depressed state that occurs after
an event or change. Typically reactive depressions are less severe
than major depression and there is little role for medication. A
reactive depression is common after Stroke and may occur in combination
with a major depression.
When a person has a Stroke there are a number of things that will
happen. For many people, if the Stroke involves hospitalisation
it will be their first contact with a system that is new and therefore
they are unfamiliar with. The common theme in reactive depression
is the state of transition. Most people fear change and it is seen
as a stress. All of us grow up with a set of coping mechanisms.
The commonest scenario is the half empty jug situation, a person
with a positive cognitive will see the jug as half full, a more
negatively inclined person will be upset that the jug is half empty.
How a person deals with transition will be influenced by their coping
mechanisms and their set pattern of cognitive sets (belief systems).
A Stroke is a time of transition. The person who has the Stroke
may have to learn how to do things differently; they may need to
rely on someone else for things that in the past they could easily
do themselves. Often the greatest transition after a Stroke is the
change from independence to dependence. However, other changes also
occur - there may be the change from working to retirement, physical
activity to inactivity, acute mental ability to slower thinking,
driving oneself to relying on others and the list goes on. The transition
phase is also for the family and partner of the person who has had
the Stroke and they may also go through their own reactive depression.
The most important feature of the reactive depression is the need
to recognise that it occurs and that it is okay to have some depression.
Following the recognition of the state is the process of dealing
with the depression. This is a dynamic process and the focus of
the treatment will need to be on the current issues as the situation
post Stroke is usually a changing one.
The management of the transition involves talking therapies. This
can be obtained from rehabilitation counsellors, psychologists,
psychiatrists, and general practitioners. Community health centres
and the local hospital are often the place you will find people
with the necessary expertise to help in this time of transition.
The rate at which the person will respond to the treatment will
vary according to how flexible they are in their thinking patterns
and how great the changes have been. Every person will have his
or her own unique timetable of adjustment.
The process of the counselling is to identify unhelpful thinking
posterns and suggest ways that the person may change their thinking
style. Stages of change are mapped out for the person so that they
can see the road to recovery. In the course of the treatment, the
therapist aims to help the person face the changes that have occurred,
reduce the patient’s fear of the changes and see that the
new situation does have positives. Transition counselling needs
to occur in conjunction with all the other post Stroke therapy.
Often it may occur very informally in the course of the various
therapies. Overall, people will respond to the therapies and recover.
Article courtesy of Dr. Patricia Jungfer
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© Stroke Recovery Association NSW
PO Box 3401 PUTNEY NSW AUSTRALIA 2112
Telephone: + 61(02) 9807 6422 or 1300 650 594
Fax: + 61(02) 9808 6173
email :info@strokensw.org.au
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