Post-stroke depression (PID) is an emotional disorder, expressed in a sharply reduced mood, lack of vitality and desire to fight for oneself. This condition occurs in a third of stroke patients. This happens as a result of damage to certain parts of the brain, as well as the very awareness of the patient of his helpless state, a pessimistic perception of the future.
The problem is that depression after a stroke deprives the victim of the will to fight. Without it, the full restoration of physical and cognitive functions becomes impossible. Moreover, PID dramatically reduces the patient’s chances of survival. In view of this, one of the most important tasks of rehabilitation physicians is the fight against post-stroke depression, on the main methods of which we will dwell.
Causes of depression after a stroke
Lack of stress resistance, unstable psyche before a stroke
There is a category of patients who, due to their temperament or experienced traumas, are more prone to depression than others. These are people of a neurotic type, melancholic, patients with PTSD and other mental illnesses.
When a crisis as serious as a stroke occurs, these patients break down. Their psyche lacks its own resources to recover. In view of this, medical staff and relatives of especially psychologically vulnerable patients should be carefully monitored for those who do not have signs of depression after a recent stroke.
Acute reaction to what is happening
Incapacity, paralysis, problems with speech and coordination – such problems can drive even an emotionally stable person into depression. Many people after a stroke feel that life is over. And the more active the patient was before the crisis, the harder it is for him to experience his own helplessness after it.
Oxygen starvation of the brain
In 85-90% of cases, depression after a stroke is caused by physical causes: hypoxia and death of brain cells. In the lesion, communication between neurons is disrupted. There is a deficiency of serotonin and other neurotransmitters that regulate emotions.
These processes lead to an “automatic” decrease in mood. A person cannot influence the production of serotonin, just as he cannot change the composition of his own blood by willpower. Without medical treatment, neurotransmitter imbalances lead to chronic depression.
severe consequences of a stroke
Particularly severe consequences of a stroke
A cerebrovascular accident can affect larger or smaller areas of the brain. In about 30–40% of patients, small areas of the lesion are damaged. If medical assistance arrives on time, such patients recover quickly. During the first months, they begin to speak, regain the sensitivity of their limbs, move first in a wheelchair, and then on their own two feet.
60-70% of stroke victims experience more severe brain damage that results in partial or complete disability. More than half of these patients – especially those over the age of 70 – remain bedridden. One- or two-sided paralysis of the body, complete dependence on other people inevitably lead to PID.
Lack of support from loved ones
It is hardest of all for lonely patients who can only rely on the compassion of the hospital staff. However, the presence of a family does not always save from depression after a stroke, because some relatives perceive the victim as a burden. When other factors — extensive brain damage, paralysis, mental instability — are added to abandonment and loneliness, avoiding depression is almost impossible.
The main signs of depression after a stroke
The first step in the treatment of PID is to identify its symptoms in a patient. You can determine that a patient is suffering from depression by the following symptoms:
persistently depressed mood;
feeling of deep depression;
loss of interest in life;
vision of the future in black light;
a premonition of impending disaster (in particular, a second stroke);
a state of stupor in moments of maximum despair;
inability to enjoy the simple joys of life: favorite dishes, programs, pleasant communication;
lack of appetite;
a sharp decrease in body weight;
irritability and outbursts of rage, accompanied by restlessness;
signs of depression after a stroke
unwillingness to engage in post-stroke rehabilitation;
complete lack of initiative;
wandering pains that spontaneously arise in different parts of the body;
mental “retardation” with an equally negative attitude towards all people without exception.
The dangers of undiagnosed depression
Early detection of PID plays a key role in all further rehabilitation of the patient. The beginning of depression is evidenced by the following: the patient fell into a state of apathy, began to talk about his uselessness and the meaninglessness of further existence. As soon as these symptoms appear, you should immediately involve a psychotherapist in treatment.
Running depression after a stroke significantly reduces the patient’s chances for full rehabilitation and return of previous mobility. Negative thinking, isolation, depressed mood lead to a decrease in the rate of brain recovery. Lack of initiative and desire to fight make a full recovery almost impossible.
The saddest consequence of neglected depression is a decrease in the body’s resistance. In this condition, the patient’s immunity drops sharply. Concomitant diseases develop: inflammation of the respiratory system, atrophy of the gastric mucosa, bedsores, etc. In the end, a person is doomed to death. With his negative thinking and inactivity, he himself brings it closer.
How to overcome depression after a stroke
To exit the PID, the right, optimistic attitude is important. Psychological overcoming of the problem goes through several stages:
Negation. Immediately after a stroke, the victim cannot believe what happened. He convinces himself that this is a nightmare, a terrible mistake.
Anger. After realizing the stroke as a fait accompli, the patient becomes furious. He begins to blame others, relatives, medicine, and the state for his misfortune.
Bargaining. At the third stage, the patient begins to “bargain” with higher forces, who are supposedly responsible for his fate. These can be doctors, evil fate, God, etc. Patients give some kind of vows, promise doctors “mountains of gold” for a quick cure from an insidious disease.
Despair. The fourth stage is characterized by the realization that there is no magic pill. This is where the depression actually begins. A person falls into deep despair, loses the will to live.
Adoption. most productive stage. Having resigned himself to his new position, a person accepts it and begins to act according to the circumstances: diligently perform breathing exercises, “sweat” on simulators, etc.
The main task of the medical staff and relatives is not to let the patient get stuck in the fourth stage. Here much depends on the consciousness of the patient himself, the stability of his psyche. People with a strong will and high resistance to stress often fight for life “against fate”. For them, such a catastrophe as a stroke becomes another test of strength. Patients with such a temperament belong to the most promising group of patients. They are actively involved in rehabilitation, doing everything possible and impossible to get back on track.
Patients with a less stable psyche need medical and psychological assistance.
How to overcome depression after a stroke
First of all, the patient needs to understand that what happened to him is not a punishment and a monstrous injustice. A stroke is a disease that can happen to anyone. Thousands of people fall ill with it every year.
Grief over what has already happened is unproductive and pointless. It is better to direct your efforts to rehabilitation, drink the medicines prescribed by the doctor, and do exercises. The body has enormous resources for recovery. It is only necessary to help him.
What to do for the family of a patient with depression after a stroke
Since the support of loved ones is essential in overcoming depression after a stroke, the relatives of the victim should know how to help him. Psychological assistance to such patients includes several aspects:
Maintaining a healthy indoor climate
Relatives should not focus on the helplessness of the patient after a stroke. He should be supported, reassured and encouraged with all his might. All unresolved conflicts that previously existed in the family should be forgotten. Forces to send to the rehabilitation of the victim.
Behavior with the patient according to the principle “you are not a burden”
The patient after a stroke, of course, is severely limited in movement. He has to be looked after and looked after. All this burdens the victim and his family members. Makes serious changes in the daily schedule of life.
However, the patient should not be told that he is a burden. It is important to maintain in him confidence in his own necessity and significance for other members of the family. In order for this confidence to grow, it is advisable to give the victim small instructions, to entrust feasible deeds.
Providing comprehensive treatment and care
It is important for relatives to remember that a stroke is not a cold that goes away on its own after 7 days. Violation of cerebral circulation should be treated qualitatively by taking a complex of drugs, performing rehabilitation measures (massage, exercises, physiotherapy), providing round-the-clock nursing care.
Organization of communication
Many families are “embarrassed” to show their sick relative to their acquaintances. He is literally locked within four walls, limiting communication with others as much as possible. This is fundamentally the wrong approach. It severely limits the patient’s recovery options and exacerbates PID.
In order not to develop depression after a stroke, the patient must communicate a lot. With relatives, neighbors, friends, former colleagues – anyone who wants to visit and talk to him. Even if the conversation itself is difficult for the patient, his attempt to keep the conversation going, pronouncing the words in his mind is a powerful stimulus for restoring neural connections.
Features of the treatment of depression after a stroke. Medical therapy
Pharmacology comes to the fore in this process. Depression of any type is a serious mental illness, the causes of which nest in the structures of the brain. It is impossible to influence physiological disorders by suggestion alone, therefore, the following medicines are used for the treatment of PID:
Antidepressants. These drugs contain substances that correct the balance of serotonin, norepinephrine and other neurotransmitters. They “chemically” improve mood, help the patient adapt to new conditions of existence. The list of antidepressants most commonly used after a stroke includes Paroxetine , Sertraline , Fluoxetine, Cipramil , Fevarin , etc.
Psychostimulants. These drugs increase the activity of the psyche, eliminate apathy, reduce social alertness. It becomes easier to communicate with the patient. His attacks of aggression and isolation disappear. The list of popular psychostimulants includes Ritalin , Provigil ,
Desoxinate , Focalin . After a stroke, they are usually prescribed in combination with antidepressants.
Atypical neuroleptics. This pharmacological group is used to prevent cognitive impairment and other complications of PID. The most effective drugs: Clozapine , Olanzapine , Quetiapine , Periciazine , Ziprasidone .
All medications listed are prescription drugs. The right to prescribe them, set the dosage and duration of treatment is only with a psychiatrist or psychotherapist who observes the patient and knows his needs well.
In addition to taking medications, auxiliary methods of treatment are also used to eliminate depression:
One of the most powerful means of dealing with depression of any kind is psychotherapy. It can be individual or group. Works well with a combination of both methods. During the session, the patient gets the opportunity to voice their fears and anxieties. It relieves stress, helps to accept the situation.
The psychotherapist provides the patient with moral support, suggests ways to solve existing psychological problems. Reception of antidepressants this method will not replace.
However, it really helps stroke victims a lot thanks to the interested human participation of the doctor.
Increased physical activity stimulates the production of pleasure hormones in the brain. Even healthy people experience euphoria after a morning run and a contrast shower. For patients after a stroke, exercise therapy is a real salvation. Therapeutic gymnastics stimulates the brain, accelerates the recovery of physical functions, improves mood.
Even if the exercises are given with great difficulty, they must be continued. Gradually, the body adapts to the loads and learns to perform simple movements. Each small victory over oneself will bring colossal moral satisfaction to the patient.
Man is a social animal. The entire surface of his body is strewn with microscopic receptors, the main function of which is to touch the surrounding objects and the touch of other people. Stroking the skin soothes, relieves anxiety, gives great pleasure. For this reason, 99.9% of people love massage.
It also works great for depressed patients. Massage is included in the compulsory rehabilitation program after a stroke. It gives the patient a sense of care, lowers the level of aggression, and prevents self-isolation. In addition to a positive effect on the psyche, massage also improves blood circulation and develops the sensitivity of the limbs.
Massage after a stroke
This is a new technique for the treatment of PID, which consists in exposing the brain to low-frequency electrical impulses. The current activates the necessary parts of the brain. The patient’s level of hormones of joy rises, lost neural connections are restored.
You can also get rid of a depressed mood with folk remedies. Angelica infusion is considered one of the most effective. To prepare it, 2 tablespoons of dry raw materials need to be poured with a glass of boiling water. Then stand the infusion for 6 hours in a dark place and strain. Drink 50 ml 4 times a day.
Many of these funds can be used at home, after the patient is discharged from the hospital. However, this should only be done under medical supervision. In some cases, it can be combined with the intake of neuroleptics and antidepressants, without which especially severe patients with depression cannot do without.