Preventing depression after stroke
Depression is an often neglected area of stroke recovery as healthcare professionals and researchers focus on the more obvious, physical outcomes. As many individuals have difficulty acknowledging or seeking help for depression, the condition is frequently missed and poorly managed. Around 60,000 people are affected by stroke annually in Australia with over 50 million stroke survivors world wide; since one in three stroke survivors experience depression, this is a significant public health problem.
A recent update of a Cochrane Review determined whether pharmaceutical treatments or psychological therapies, started early after stroke, can prevent depression and improve physical outcomes in stroke patients.
Author Dr Maree Hackett and colleagues at The George Institute and The University of Leeds reviewed 14 trials that were designed to compare drug treatment with placebo or psychotherapy with standard care to prevent depression in patients with stroke. "We found a small but significant effect of psychotherapy on improving the mood of stroke patients and preventing depression. There was no evidence however, that antidepressant drugs prevent depression or improve physical recovery in this patient group," said Dr Hackett.
"The term depression is commonly used these days to describe feeling sad or down, and this may be a natural reaction following a stroke. However, for one in three survivors these feelings of depression are persistent and they start to interfere with patients’ day-to-day lives. This is the depression we need to prevent," said Dr Hackett. "When people feel depressed they may feel isolated or worthless, their sleep patterns may change and they are tired, irritable, stop their rehabilitation, stop socialising or going to work. This is when depression becomes a problem, not just for the stroke survivor, but also for their family and friends."
There has been little information to guide clinicians and researchers as to how to prevent depression after stroke. While the studies in this updated review show that psychological therapy prevents depression, it is unclear if these benefits can be generalised to all stroke survivors due to the small number of patients who took part in the trials.
The George Institute for International Health is currently planning a detailed research program to further investigate effective management strategies for patients with stroke, and to encourage the further education about depression in the context of physical illness.