Understanding Post Stroke Depression

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Surviving a stroke is not the end of a medical issue. It's the start of a new journey, with new challenges. Major depression is often one of those challenges. It interferes with recovery, rehab, adjusting to a new life, and maintaining relationships.





In short, it's big problem. And it's pretty common.





According to new research by Dr. Laura Stein from the Icahn School of medicine, depression after stroke is twice as likely to occur as depression after heart attack. There's something unique about stroke that leads to depression.





On top of that, if a person lived with Generalized Anxiety Disorder before stroke, they are 1.7 x as likely to experience Major Depression after stroke.





In this conversation, Dr. Laura Stein talk about her research and what survivors, caregivers, and medical practitioners need to know.







Bio







Laura K. Stein, MD, MPH is an Assistant Professor of Neurology at the Icahn School of Medicine at Mount Sinai and attending physician at the Mount Sinai and Mount Sinai Queens Stroke Centers. She is board certified in Neurology and Vascular Neurology by the American Board of Psychiatry and Neurology. Dr. Stein received a BA from Amherst College and her MD and MPH from the Icahn School of Medicine at Mount Sinai. She completed her internship, neurology residency, and vascular neurology fellowship at Mount Sinai.





Dr. Stein's interests are in stroke clinical care, stroke outcomes research, and medical education. She is the Neurology Residency Associate Program Director and precepts first year medical students in the Art and Science of Medicine preclinical skills course. Dr. Stein received the Department of Neurology Resident Class of 2020 Award of Appreciation for Dedication & Commitment Towards Excellence in Mentorship and 2020 Institute for Medical Education Excellence in Teaching Award.







The Research



Dr. Stein's research was part of the American Stroke Association’s virtual International Stroke Conference. You can read the paper here.





You can read the article where I first encountered her work here.





The approach of looking at depression after heart attack vs looking at depression after stroke is an interesting one. It's a nice way of controlling for other potential causes.





The research looked at Medicare recipients, Medicare is a US government health insurance program, generally for folks 65 and older. It lets researchers draw from a rich collection of data. There are two significant tradeoffs, of course.





First, it's restricted to the US so there's no international representation in the study. Obviously, depending on the research question in particular, that may or may not be an issue.





Second, it's restricted to folks 65 and older. Can we say that the results of this study apply to younger stroke survivors?





Maybe?





Probably?





We don't know. And this study was not designed to answer that question. I'd say it does get us closer, though, and it opens up an opportunity to do further research that asks different but related questions.





That's what good studies do. The answer specific question with solid evidence and clear analysis. And the result can introduce new questions for researchers to explore in different studies.





In the meantime, it's likely safe to say, that regardless of age, stroke survivors are probably more likely to experience depression, and the community needs to be vigilant for the signs of depression and seek treatment accordingly.







Symptoms of Major Depression



Diagnosing depression involves identifying symptoms from a couple lists. To "earn" a depression diagnosis, a patient needs 5 symptoms from list 1 and all 4 from list 2. They are:





List 1 (Pick 5 or more)





Depressed Mood (most days) Loss of Interest or pleasure Weight loss or gain Insomnia or hypersomnia (nearly every day) Psychomotor agitation or limitation Fatigue (nearly every day) Feelings worthless or experiencing inappropriate guilt Decreased concentration (nearly everyday) Thoughts of death or suicide



List 2 (All 4)





Symptoms cause significant distress or social/professional impairment Symptoms not attributable to a substance or medical condition Symptoms not explained by another disorder No history of manic episodes



You can read more details about the symptoms here.





You can probably see one of the issues. Many of those symptoms may be directly attributed to the disabilities and brain damage of the stroke without it being Major Depression. That's why it's important to work with a medical professional to tease them apart.







Symptoms of...