Depression after stroke

[cougarnurse]

Thought this was interesting: MedlinePlus: Depression After Stroke Can Be Debilitating
THURSDAY, March 27 (HealthDay News) -- Depression stops stroke victims from returning to work almost as often as physical disability does, Australian researchers report.
The study of 210 men and women, average age 55, who had paying jobs before a stroke found that 112 of them returned to work within six months -- about the same ratio as in a recent U.S. study, said researchers at the George Institute for International Health in Sydney. Their report appears in the March 28 issue of Stroke.
In developed countries, roughly 20 percent of stroke victims are still young enough to be part of the workforce, the researchers noted.
Of those study participants who went back to work, 71 percent were rated as physically independent. Thirty-three percent of those working were diagnosed with post-stroke depression, compared with 45 percent of those who had not returned to their jobs.
"Physicians should continually assess patients' mood after a stroke, because it's an important predictor of whether patients will go back to work," study author Dr. Nick Glozier said in a statement.
Only 30 percent of the stroke survivors with depression had received treatment for their psychiatric problem, the researchers found.
Comments?

[cougarnurse]

More on the study:
"We know that people who have gone through an illness such as a heart attack or stroke have a higher incidence of dysphoria or anxiety after the event," said Joanne Festa, an assistant professor of clinical neuropsychiatry at Columbia University who has done work on post-stroke depression.
"Having an acute illness such as a stroke in itself is upsetting," she said. "And, of course, with a stroke there is the possibility of cognitive impairment leading to depression. These people should be assessed, and any depression should be treated."
Younger patients in the Australian study were more likely to have post-stroke depression. Depression was more likely if the stroke was severe.
Family members should watch for signs of depression in someone recovering from a stroke, said Glozier, associate principal director of the institute. A physician should then be notified so that treatment might begin, he said.
"There is some evidence that antidepressants work in post-stroke depression, and there are indications that we may be able to prevent depression with psychological intervention, such as cognitive behavioral therapy-style motivational interviewing," he said.
A number of studies have found a high incidence of depression after stroke, sometimes in 70 or more percent of cases, Festa said.

[KristenLouRN]

Stroke is a process that teaches those involved patience. I work for a woman whose mother, "Mary" had a severe stroke. She was told that because of the severity of the stroke, she probably wouldn't survive, but against all odds she did. After Mary was out of the ICU, later discharged from the hospital and directed towards a rehab facility she did extremely well. Those who followed her progress thought she would be back walking and talking within three months post stroke. The turn of events that happened after Mary left the rehab facility were not of that which were predicted. She continued to do well with physical, occupational and speech therapy while recuperating in her daughter's home. She was surrounded by maximum support and the best care possible by nurses, therapists and the family. Slowly though, Mary's progress began to diminish. Slight changes in her walking were noticeable and she began to vocalize less and less. She wasn't as alert and continued to sleep more often. When the daughter brought this to the doctor's attention, he altered Mary's medication and to no avail did the family she any positive changes. Because of Mary's sensitivity to medications, the family thought that possibly it would take her time to adjust to the medication changes. When the daughter suggested that an MRI be done, it was denied. The doctor was reluctant to do the MRI because he thought that her slowed progress was due to depression, which is common after a stroke. After a period of approximately 9 months and Mary's condition worsening, the daughter demanded an MRI be done. Mary, minimally able to vocalize, showed visually to be having severe headaches. She was squinting and holding her head in a downward angle, much like she had before her stroke when she complained of "the worst headaches of her life". When the MRI results came back, it showed that Mary's ventricles in her brain were severely enlarged and was diagnosed with hydrocephalus. A shunt needed to be placed immediately to slowly drain the CSF and to see progress in her condition it would take about a year. The family was happy to know what had caused their beloved family member's digression and was hopeful that they would see the results they did when Mary first came home from the hospital. Unfortunately, although no doctor would confirm it, the hydrocephalus caused diffuse damage on the brain because of its severity and how long it had gone undiagnosed. Typically, once a patient leaves a rehab facility, the doctor suggests or automatically orders an MRI to be done 6 months after a stroke has occurred. In this case, the family was not told this information and surprisingly when the daughter had asked specifically for it to be done, the doctor didn't see the need for it. Many medications have been tried for Mary during this ongoing 3 year process. She has been on Ritalin, Bromocriptine, Amantidine and Aricept to name a few. In putting Mary on some of these medications there is a Catch 22. She may see some progress in motor planning and walking, but it increases her chance of seizures. Mary is on Keppra for her seizures and any decrease in it has caused Mary to have a grand mal seizure. In the last 6 months, Mary has had severe headaches and the valve in the shunt showed to be draining too much of the CSF off her brain. She had to have another surgery to change the valve size in the shunt and it was said that it would help decrease the number of headache she was having. Mary has daily bone crushing headaches that she needs to be medicated with hydrocodone in order to give her any relief. When she is awake, she is in pain because of the headaches and when she is medicated for the headaches, it causes drowsiness and she sleeps. It is a rare occurrence for her to be able to be awake and enjoy her family. Today, after another MRI was conducted, it showed that Mary has increased white matter in brain indicating dementia. The family is devastated. I will graduate in May to be a Registered Nurse and I have watched first hand how doctors can let a patient slip by and not monitor their progress closely enough. I have listened to a family be so frustrated and not understand why the doctors won't listen when they are the ones around the patient every minute of the day. But as a nurse I can tell you, I listened to the family. I listened to their concerns. I researched questions that they had and I wasn't able to answer. I didn't settle for "I don't know". I wish I was able to tell them more and at times I wished i was a doctor so that i could help them like all the other doctors didn't. I will continue to care for Mary and give her my utmost respect. I will be there for the family when they continue to ask questions about this new dilemma they have to now face. I just wish a doctor had listened to the family. I wish he hadn't just blamed it on depression after a stroke.