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Depression After Strokes Common

When our primary care doctors in Delray Beach heard that Sen. John Fetterman (D-PA) had checked himself into the hospital for depression following his stroke last year, we were not surprised.

That’s because depression is a common reaction after a stroke. And if you’re thinking that it would be normal to be depressed following such a serious medical event, you should know that researchers think there’s more to it than that.

A Common Aftereffect

Fetterman survived a near-fatal stroke last May. The prompt medical care he received helped him recover rapidly, the only apparent lingering result with an auditory processing disorder (making it sometimes hard for him to hear and understand the spoken word).

But last month he “checked himself into Walter Reed National Military Medical Center to receive treatment for clinical depression,” his chief of staff, Adam Jentleson, said in a statement.

“While John has experienced depression off and on throughout his life, it only became severe in recent weeks,” he added.

Many experts attributed the delayed onset of his depression at least in part to his stroke.

“Post-stroke depression is very, very common,” Dr. Lee Schwamm, a neurologist at Massachusetts General Hospital who is not involved in Fetterman’s care, told NBC News.

“Estimates are somewhere up to a third of patients with stroke will have depression at some point after their stroke,” he said.

Those with a previous history of depression, like Fetterman, appear to be more at risk.

“We know that folks with a history of depression after they have a stroke, they’re at much higher risk of post-stroke depression,” Abigail Hardin, a rehabilitation psychologist and assistant professor at Rush University, told CNN.

Causes Unclear

Unfortunately, scientists are still unsure of the cause.

“There’s not a lot of data behind the reason, but one idea is that stroke itself messes up the brain’s ability to function well—not just the part of the brain where the neurons are affected by the actual stroke, but the way the different brain regions talk to each other,” Dr. Woll Cronenwett, chief of psychiatry at Northwestern University Feinberg School of Medicine, said in a news release after hearing about Fetterman.

Such brain changes might lead to thinking difficulties affecting how people perceive the world, and that in turn could lead to depression, he said.

Whatever the cause, the American Heart Association (AHA) reports that adults who have had strokes are more likely to become depressed than those who have had heart attacks, according to two 2021 studies.

One study found that people who had strokes were nearly 50 percent more likely to develop symptoms of depression than those who had heart attacks, while another found that women were 20 percent more likely than men to develop depression after a stroke. And the risk remained high for at least a year and a half after the stroke.

“We did not expect that the cumulative risk of depression would remain so persistently elevated,” Dr. Laura Stein, a researcher on both studies, said in a news release.

“This finding supports that post-stroke depression is not simply a transient consequence of difficulties adjusting to life after stroke,” she added.

Bravery in Sharing

Many lauded Fetterman not only for seeking help but also for going public with his condition. When Patrick Kennedy, son of the late Sen. Edward Kennedy, was in Congress, he would sneak in treatments for substance abuse during congressional holidays.

“This is a moment for us to tear down the stigma of depression and anxiety,” Kennedy, who retired in 2010 and has become a leading voice on mental illness, told ABC News.

“Senator Fetterman may do more for people just by admitting that he’s getting help for depression than any bill he ends up sponsoring,” he added.

While we don’t know many specifics about Fetterman’s particular case, according to the National Institute of Health (NIH), up to 80 percent of those treated for depression show an improvement in their symptoms generally within four to six weeks of beginning medication, psychotherapy, attending support groups, or a combination of these treatments.

And because Fetterman is receiving inpatient treatment, it will be easier for doctors to provide intensive therapy, and to monitor and adjust his medications as necessary. This means he’s likely to recover faster.

Symptoms, Treatment, Prognosis

According to the American Stroke Association (ASA), some of the most common symptoms of depression include:

  • persistent feelings of sadness, anxiety, or “empty” mood
  • restlessness and irritability
  • feelings of hopelessness, pessimism, guilt, worthlessness, or helplessness
  • loss of interest or pleasure in hobbies and activities including sex
  • decreased energy and fatigue or feeling “slowed down”
  • difficulty concentrating, remembering, and making decisions
  • insomnia or sleep disturbances
  • appetite and/or weight changes
  • thoughts of death or suicide, or suicide attempts

Depression can be mild, moderate, or severe. Clinical depression, the most severe form, is diagnosed when an individual has five depression symptoms every day, nearly all day, for two weeks.

There are a number of treatments for depression, including antidepressant medications, psychological therapy, or both, according to Kristen Carpenter, a chief psychologist in the department of psychiatry and behavioral health at Ohio State University College of Medicine.

“Many patients struggle and suffer with these symptoms for a long time before seeking or getting the help they need,” she told CNN.

“The key is getting care,” she said. “The vast majority of people will have their symptoms remitted with proper treatment through psychotherapy and/or medication.”

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