Seventeen years ago when I worked in a psychiatric hospital, a 60-year-old woman was admitted one year post stroke. She appeared depressed, looking sad and hopeless as she shuffled around. She had no facial expression and didn’t speak, despite the absence of aphasia or other language impairment. I asked the psychiatric resident if he thought she was depressed. He said no, the symptoms were the result of her stroke, not depression. So she was not treated for the depression. Greater knowledge and understanding of stroke have developed since then, and today the answer to that question would likely be yes...she’s had a stroke and she’s depressed.

The facts
Depression in stroke survivors often goes undiagnosed. According to The National Institute of Mental Health, 10-27% of stroke survivors develop a depression. An additional 15-40% will have some symptoms of depression within two months following their stroke. Others in the field of stroke believe that nearly 75% of stroke survivors will experience some depressive symptoms. Often the symptoms in stroke survivors go unrecognized because the lethargy, sad mood and loss of interest are attributed to the stroke. The fact is, both problems—stroke and depression—can and do exist simultaneously in stroke survivors.

What is clinical depression?
A clinical depression is not the periodic everyday blues. It is a combination of five or more of the following that last for two or more weeks:

•	Persistent sad or “empty” mood or irritability
•	Excessive tearfulness
•	Decreased energy, fatigue, being “slowed down”
•	Loss of interest or pleasure in ordinary activities
•	Sleep disturbance: insomnia, oversleeping, early morning awakening
•	Difficulty concentrating, remembering, making decisions
•	Appetite changes (weight gain or loss)
•	Feeling helpless, hopeless, worthless, guilty
•	Chronic aches or persistent pains for no apparent reason
•	Thoughts of death or suicide; suicide attempts

What causes depression and how is it the same
or different for stroke survivors?
There are many possible causes of depression. Loss: Death of a loved one, divorce or loss of functioning due to a medical problem like stroke; Genetic Predisposition: Research demonstrates that a family history of depression can predispose one to depression. Although it does not mean other family members will become depressed, they have a greater risk of developing a depression. Stroke is an injury to the brain resulting in chemical and functional changes. With strokes in the left hemisphere of the brain, especially with frontal lobe injuries, there is a greater risk that a depression might occur.

Diagnosing depression
It can be difficult to diagnose depression in stroke survivors. When reviewing post stroke and depression symptoms, it’s evident that many are similar. So while it may be understandable to attribute fatigue, poor memory/concentration, loss of interest in activities, and tearfulness to the stroke, these are also manifestations of possible depression. Such symptoms should be discussed with your doctor or health care professional to determine whether a depression exists. Untreated depression in stroke survivors can last almost a year. Undiagnosed and untreated depression will seriously impact the ability and motivation of a survivor to work in rehabilitation. Once treated, the survivor has more interest and energy to invest in recovery and resuming their life.

How to help yourself, a family member or a friend
Depression makes people feel like giving up. Negative thinking often takes over. Here are some tips:

•	Don’t focus on negative thoughts; praise yourself for small accomplishments.
•	Set priorities and break large tasks into smaller ones.
•	Depressed people will isolate; push yourself to be with others and engage in activities.
•	Do things that make you feel better or give you pleasure.
•	Some depressed people feel they are crazy or weak; remind yourself daily you are neither.
•	Talking to a mental health counselor can be very helpful.
•	Medications may be indicated for more serious depressions. If recommended, take them. In most people it takes two to four weeks to see results, so don’t expect to feel better after a couple of doses.
•	Depression doesn’t disappear overnight. With support from family, friends, counseling and/or medications, one will feel better over time and resume experiencing energy and pleasure in their life.

If you feel a stroke survivor may be depressed, support them in seeing a mental health professional. Several medications are successful in treating depression and helping people feel more like themselves again, and more able to deal with the challenges stroke poses in their lives.

For more information write to:
D/ART/Public Inquiries
National Institute of Mental Health
Room 15-C-05
5600 Fishers Lane
Rockville, MD 20857

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