Post-Stroke Depression and Antidepressants

Summary

Research indicates that antidepressants may be effective at decreasing depressive symptoms and increasing physical funtioning after stroke.

In the United States, over 795,000 strokes occur every year, and it is a leading cause of long-term disability. Post-stroke depression (PSD) is a common neuropsychiatric complication with prevalence rates ranging between 39% to 52% during the first 5 years after stroke The negative effects of PSD include increased disability, cognitive impairments, mortality, suicidality, and decreased functional rehabilitation and quality of life. Diagnosis and treatment of PSD is complicated by its complex etiology and post-stroke impairments (e.g., cognition, communication, and emotion). Both psychosocial (e.g., role change due to disability) and physiological factors (e.g., lesion location, biochemical dysfunction), may contribute to PSD.  Therefore, PSD is considered to be a biopsychosocial disorder.

Antidepressants are one of the main treatments for PSD and contribute to improving biochemical dysfunction and functional recovery.  Selective serotonin reuptake inhibitors (SSRIs) are the most recommended because they are generally well tolerated.  However, other classes of ADs are shown to be effective and may have advantages for treating co-occurring conditions or in situations where SSRIs are not tolerated or contraindicated..   For example, noradrenaline reuptake inhibitors (NARIs) have been effective in treating PSD characterized by psychomotor problems and serotoninergic and noradrenergic reuptake inhibitors (SNRIs) have been effective in treating PSD with emotional unawareness.   Yet other research indicates that tricyclic antidepressants (TCAs) have a higher response rate for treating PSD when compared to SSRIs. Therefore, effective treatment of PSD may involve selecting antidepressants most suitable for the individual. 

PSD is a complex disorder with multiple causes.  Effective treatment for depression includes antidepressants, which are especially effective for individuals after stroke. Antidepressants are effective as demonstrated by several studies because they help improve neurochemical dysfunction, decrease depressive symtoms, and contribute to improved functional recovery.

Read the full paper on post-stroke depression and antidepressants

The beginning

What is the brain? Is it biological jello sloshing around in a chemical cocktail? Is it the seat of the soul? Honestly, I didn’t think about any of this until three years ago, because that’s when I had a stroke. Unlike other turning points in my life – leaving home, moving to America, getting married, having kids – nothing was ever as stark as the before and after of having a stroke.

But I was lucky. I sometimes joke that the only bad thing to come out of having a stroke was a slightly numb toe and a midlife crisis. This is true, but it’s more than that. It’s as if I sleepwalked into the hospital as a young woman and left shell-shocked and middle-aged. Afterwards, I desperately wanted to start living my life while still in the confines of my old one. Much like that nightmare where you’re being chased by something awful, but you can’t move your legs. I don’t fear death, I know it’s chasing all of us, but I desperately want to live a fuller, more vital life. No more sleepwalking.

I would like to say that I had an epiphany and decided there and then to follow my dreams with laser focus. Change the world, be a better person, climb a mountain, be daring and bold. As strange as it seems, part of me wanted to relive that curiously exciting, but fear filled, period of being in the hospital when my life, as I knew it, was held in the balance. The edited version of my life since then is quite impressive – sold my business, returned to school, managed to be a mother to three boys while achieving academic excellence, all with the goal of learning about the brain so that I can help others and make a difference in the world. But that is most definitely the edited version, although not exactly a lie, much of it was built on doubt and anxiety. The truth was that initially I just wanted to have fun, to feel all the feels, and – most importantly – if I got out of the hospital in one piece, I was most definitely getting a convertible.

Yes, I eventually got my convertible, but in those first weeks and months, I was mostly compelled to create art. As a creative person who always identified as being “artistic,” I was surprised and a little ashamed that I had not made art in over fifteen years. Much of this initial post-stroke period was taken up obsessively drawing and listening to music loud enough to feel on the inside. Looking back on it now, creating art was the best therapy, allowing me to work through the stickiest part of my existential crisis.

Now three years on, my existential crisis is more mindful than paralyzing. Balancing my return to school with being a mother and wife takes precedence over creating art. But creativity and art is never too far away and I find it in unexpected places, like science. In fact, the monochromatic angiographs that depicted my brain’s blood vessels as they sadly spasmed seemed oddly artistic. Reminiscent of etchings that I loved to create, I found them inspiring. Indeed, these actual images are the basis for the artwork that I created for this piece. In them I see art and science; I see life as it changed.

Recently, my neurologist asked me if I’d worked out the brain yet–he knew that I had returned to school to study psychology–the answer is, and will always be, “no.” My curiosity has led me to find answers to questions I never knew I had, but for every question answered a new one takes its place. Our brains lie at the intersection of our bodies and our selves, fueled by experience and environment, people and places. That’s a lot of variables to work with and a multitude of questions to ask. My questions now are what have I learned from my own experience and how can that help others. How can I combine art and science? Will my ideas take shape or will the day-to-day take their place? What I do know is that life will never be the same, because having a stroke was the best-worst thing to happen. It changed my life for the better.

Art and science. Life and death. Atoms, cells, organs, individuals, communities, society, and the universe — they’re really all part of a continuum. It’s scary, it’s beautiful, and it’s all we have.