Depression and emotional reaction is very common after stroke. Some of the changes
in mood might be caused by the stroke and the effect on the brain and so perhaps some
of the depressed mood or the decrease in motivation which is common in depression is a direct
effect of the stroke and some people get a fluctuating mood which may be a direct effect
of the stroke. The very common emotional reactions, of course, are to do with the adjustment of
this huge event that's happened. It's important not to make judgements too early on about
how things are going to be. But, as time goes on, it can become apparent to people that...
Yes, they will have significant losses. Things that they were able to do, they're no longer
able to do. So for some people, this will be a very physical thing. They're no longer
able to walk as briskly or walk well or even walk. Certainly not able to work.
Distinguishing whether a person is depressed in stroke can be a bit difficult because the
common ways that depression is expressed is through emotional; that is sadness and being
depressed. People with stroke have physical effects in their bodies, so they move slowly
and could look depressed. People who get depressed lose motivation for things, so their drive
is diminished and of course there are physical effects of reduced appetite and sleep disturbance,
which are common in depression as well. Most things can be evident in stroke. Sometimes
we think, is that just the stroke? But that should not be assumed. An important part of
adjusting to a life event like a stroke, is to adjust to the giving up of what perhaps
you were previously doing or previously hoping for. Readjusting in the sense of discovering
a new life, you know discovering what my abilities are, what I am able to do and life goes on,
it's just different. Productive work which is very important for all of us in our sense
of self-esteem can change, but finding something that is useful and meaningful to do is very
important.
We know that if a person is depressed, their outcome, their recovery, their level
of functioning is severely impaired. And so depression impacts on motivation for rehabilitation,
motivation for getting up in the morning, motivation for engaging with life and treating
depression is very important in stroke.
In the first instance it's important to acknowledge it and to talk to people, just
being able to express to another person the difficulties you're having, the frustrations
you're having is important. I think there are a number of reasons why, when we're in
these sort of circumstances, don't talk to others, talk to family or talk to doctors.
One is that we might feel we're burdening other people. We can feel ashamed that, you
know, we should be coping with this. Sometimes, we think that the other person, say, the GP,
has not got time to hear this or that's not his or her job, that they're just involved
in my physical care and that's important not to think that. Care of the whole person is
very important. Some people unable to communicate clearly and that could be they have something
they want to say, but can't put it into words or sometimes they can't even form the words
in their mind and that's very frustrating. And if you can't communicate with people around
you, the GP is a person who a patient or their carer can very reasonably expect support and
help from and should talk to. There are support groups; that is groups of people who've gone
through similar experiences and that can be very encouraging and supporting to see how
other people have coped. Counselling can be very important, cognitive behavioural therapy
and in some cases, medication. Antidepressant medication is effective in treating depression
in patients with stroke.
It's important to think about the effects on the carer, that is the person who is closest
to the person with a stroke because the impact on them is enormous and maybe we could say
just as enormous as for the person with a stroke because their life is really turned
upside down.
And as well as the emotional coping, there is the daily grind of doing the things
that need to be done in this case additionally for caring for the person who needs help.
That is a major task for people going through these sort of crises both to cope with the
emotional side of things, but to cope with the practical day-to-day things. Clearly,
the task of recovery is a shared task that is shared by the patient, their carer and
also the professionals. I think it's important to be realistic about that and to understand
what the caring role is and it can be very difficult if the patient, the person with
the stroke is struggling to get motivated. It's very hard for another person to be able
to get them doing things and that's why it's so important that the whole team, the health
professionals and family are all involved.
Being a carer can be real drain on the person both physically and emotionally. It
can lead to deprived sleep and poor eating and in many ways, self-neglect. So, carers...
It's a difficult task obviously, but carers do have to look after themselves, make time
for themselves, get respite care, if necessary, to give themselves some time out. Carers can
become depressed in real clinical ways that will impede their ability to do what they
really want to do which is care. And so, they have to look after themselves and in some
circumstances, get help. And that help, as for anyone who's depressed, can be counselling
and sometimes medication.
After the acute crisis, life goes on and it's important to think about engaging
in life and it helps recovery to start to think early about engaging in doing those
things that bring pleasure. Some of the things that one did in the past may not be able to
be done but there are new things and it's important to give oneself, both for the survivor
and the carer, time doing pleasurable things, going out.
It's important to realise that help is available, that depression can be treated
and needs to be treated and should be treated. And there's a range of treatments of counselling,
psychotherapy, and medication that are readily accessible. Also, information and advice simply
about depression and why people get depressed and what is depression, can be very reassuring
to people and to understand that even though they are suffering, it's normal. And normal
does not mean to be ignored but it's... A person is not going crazy simply because they
feel stressed and depressed.
Although we can seek professional help for counselling, we shouldn't split the care
too much. Patients want to talk to their normal doctor who knows them well, understands their
physical predicament and what's happening about the emotional issues. And so doctors,
physiotherapists, et cetera should not be averse to just asking that question about
how patients are going emotionally and then directing to care if that is required.
It's important for health professionals to maintain hope. In these sort of situations,
it's easy to be pessimistic both for the patient, but also for the health professionals and
to give patients and their carers some vision for an optimistic life in the future.