The prevalence rate of stroke otherwise referred to as cerebrovascular accident (CVA), which is considered as the third most deadly disease in the world today, has been on a steady rise in the world, according to data presented by the World Health Organization (WHO). The organization indicates that approximately 15 million people suffer from stroke every year, which creates the need for having to establish a transparent health care approach through which to promote quality care when dealing with this health issue (Paolucci, Iosa, Coiro, Venturiero, Savo, Angelis, & Morone, 2019). However, it is essential to take note of the fact that stroke is often associated with psychological, physical, interpersonal, and financial repercussions, which relates to the occurrence of post-stroke depression (PSD). The sensitivity of the issue is driven by the fact that a significant number of patients often find themselves experiencing notable strains in their bid to dealing with stroke as a critical health care issue.
Depression is often seen as a neuropsychiatric manifestation occurring among stroke patients, which often hampers their ability to undergo therapy; thus, impairing their ability to achieve the best possible functional outcomes (Paolucci et al., 2019). Using the Diagnostic and Statistical Manual (DSM) V tool, PSD is diagnosed as a disorder that concerns am an individual's mood and is considered as being superimposed on another medical condition. In this case, what is clear is that the patients find themselves suffering from depression, which occurs as a result of their exposure to stroke as the leading medical condition. DSM-V diagnoses PSD as an illness that is characterized by a depressed mood or lack of interest, especially concerning treatment and therapy as part of dealing with the underlying effects associated with stroke.
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Prevalence
The frequent occurrence of the condition is considered a significant aspect, especially in the United States, as one person suffers a stroke every 40 seconds, which means that approximately 600,000 stroke cases are recorded annually. According to Mitchell, Sheth, Gill, Yadegarfar, Stubbs, Yadegarfar, & Meader (2017), PSD occurs at a rate of 33% of stroke patients; thus, suggesting that nearly 200,000 of the total number of stroke cases recorded end in exposure to depression. From a worldwide perspective, the prevalence of depression following instances of stroke is at an average of 31%, which raises serious concerns over the approaches that have been put in place in dealing with the rising number of stroke survivors in the world today.
Shi, Yang, Zeng, & Wu (2017) point to the fact that several co-existing factors predispose stroke patients to a higher possibility of being diagnosed with post-stroke depression, some of which include gender, age, and physical disabilities. The consideration of these factors is essential in ensuring that patients are accorded the best possible care and treatment in seeking to minimize their exposure to depression that can be directly linked to stroke. Ahn, Lee, Jeong, Kim, & Park (2015) take note of the fact that the condition often creates a situation where the quality of life is impacted significantly for the patients involved. Additionally, this also serves as a contributing factor towards prolonging the rehabilitation of stroke survivors and results in mortality in some of the severe cases. That serves as a clear indication of the fact that depression after stroke is a curial concern that ought to be taken into significant consideration when seeking to enhance the nature of care provided for the patients battling with the effects of stoke.
Pathophysiology
Pathophysiology of depression following a stroke involves studying the changes in mechanical, physical functions attributed to the symptoms of the disease. The extent and location of the cerebrovascular accident are crucial elements in determining the pathophysiology of the condition. To better understand the pathophysiology of PSD, it is necessary to capitalize on distinguishing aspects that relate to depression following a stroke attack and those that concern grief among the stroke survivors. According to Schöttke & Giabbiconi (2015), stroke is a sudden misfortune that may result in grieving, thereby increasing the chances of developing depressive symptoms in an individual. In that case, the sadness and grief associated with the occurrence of stroke create an emotional feeling, which is not detected by individuals with depression. Studying the condition concerning depression after stroke helps in providing evidence regarding the connection between stroke and depression, focusing on grieving and sadness that follows a stoke attack (Shi, Yang, Zeng, & Wu, 2017).
According to Robinson & Jorge (2015), depression can occur among stroke patients without displaying any warning signs, which is a common aspect in patients with silent ischemic stroke, thereby resulting in vascular depression. Vascular depression is difficult to detect among the patients considering that a patient does not display any warning signs and symptoms indicating an underlying condition. In vascular depression, ischemic lesions are necessary for hiding the warning signs considering that they help in regulating the mood of the patient, thus enabling the late onset of warning signs of depression (Mitchell et al., 2017). Studying the condition helps in providing an indication that patients with stroke tend to fall into despair, owing to the sudden feelings of sadness and grieving. The recession is associated with how the patients handle grief after stroke.
Post-Stroke Depression: Symptomatology and Diagnosis
In a bid to comprehend the risks of PSD, Schöttke & Giabbiconi (2015) take note of the fact that although the risk of depression often decreases as a patient increases in age, patients with stroke experience double the risk of depression. That serves as a clear indication of the fact that, indeed, PSD is a health issue that ought to be evaluated and researched extensively in a bid to finding viable solutions. The occurrence of the condition has significant health implications considering that it exposes the patients to frequently unrecognized or maltreated disorders. Robinson & Jorge (2015) take note of the fact that a considerable number of patients, who experience PSD, experience notable effects associated with lack of concentration and reduced cognition, which is characterized by skills and motor non-functionality.
Previous studies focusing on post-stroke depression have indicated that cases of depression among stroke patients can be separated into two main categories, which are major depression (25%) and minor depression (30%) (Ahn, Lee, Jeong, Kim, & Park, 2015). The issue in question when seeking to separate the two types of depression among stroke patients is trying to understand the extent to which patients are experiencing the impacts. Wei, Yong, Li, Zhou, Deng, Zhu, & Jin (2015) indicate that stroke patients at a 22% risk of experiencing minor depression after the first two months of being diagnosed with a stroke, which reduces to a further 8% after four months. In cases of early diagnosis of depression after exposure to stroke, approximately 56% of the patients find themselves experiencing major depression. That can be attributed to the fact that these patients often worry about their lives after their exposure to stroke, which tends to have severe implications for their health statuses.
Diagnosis of depression among stroke patients is often characterized by symptoms ranging from lack of sleep to instances where some of these patients experience a significant reduction in their appetite and suicidality (Wei, Yong, Li, Zhou, Deng, Zhu, & Jin, 2015). However, the patients are expected to go through further testing and evaluation to determine whether indeed they are suffering from post-stroke depression as may be initially suspected. The use of the DSM-V diagnostic tool helps in the effective diagnosis of stroke patients that may be suffering from depression. The tool helps in providing a criterion that ought to be considered when seeking to determine the possibility that a patient has post-stroke low. The diagnosis is undertaken by trained health care professionals, who engage the patients in interviews as a way of trying to understand some of the key symptoms that they project.
Prevention of Post-Stroke Depression
Recent studies have indicated that exposure to post-stroke depression creates a high risk of morbidity and mortality among the individual patients, as it creates a situation where it becomes hard or challenging for them to deal with the stresses associated with stroke. Wei et al. (2015) indicate that the preventive measures taken when dealing with post-stroke depression can be divided into three primary levels of intervention, which are global, selective, and targeted. However, the primary prevention method among individuals suffering from depression following stoke is elective, considering that this allows for the personalization of the prevention measures. The use of selective prevention also helps towards ensuring that the measures adopted are patient-centered as a way of improving the overall outcomes towards enhancing the ability for stroke patients to cope with their current health condition.
Primary post-stroke depression prevention involves both psychological and pharmacological approaches (Wei et al., 2015). The psychological approach consists of having to ensure that stroke patients diagnosed with depression are taken through counseling and therapy as a way of improving their abilities to cope with the underlying psychological challenges associated with stroke. A majority of the patients are taken through subconscious programs that run for periods between 6 and 8 weeks, depending on the severity of the depression recorded. The ability for the patients to recover spontaneously from the post-stroke recession depends solely on early detection of the condition. Patients with early symptoms of the condition often recover within a period of between 4 and 6 weeks of being engaged in counseling and therapy as part of the psychological approaches being considered as part of effective treatment.
The psychological intervention also includes having to provide the patients with self-helping approaches that would allow them to cope with the symptoms associated with depression independently (Wei et al., 2015). These approaches create an avenue through which patients can maximize their overall capacities to effectively handle the occurrence of the psychological symptoms considered when dealing with this type of depression. On the other hand, the use of the pharmacological approach in coping with post-stroke grief is based on the process through which to counteract the pathophysiology of stroke (Volz, Möbus, Letsch, & Werheid, 2016). Stroke serves as the main contributor to the possibility of post-stroke depression, as patients find it hard in their bid to coping with the underlying effects associated with stroke. In such cases, it becomes essential to take up a pharmacological approach through which to counteract the effects of stroke, as this would help in reducing the possibility of depressive moods.
Assessing Suicidality
The link between post-stroke depression and suicide has been highlighted in a wide array of studies that point to the fact that a significant number of these patients experience depressive symptoms that are likely to lead them towards committing suicide as an outcome of their condition. Post-stroke depression is considered an aggravating factor that affects other pre-existing conditions that include cardiovascular illnesses, hypertension, and diabetes, among others, and can ultimately lead to suicide among other patients affected. Volz, Möbus, Letsch, & Werheid (2016) indicate that post-stroke depression patients are 3.5 times much more likely to commit suicide within ten years after they have been exposed to stroke. The cases of suicide increase among patients that are physically challenged and those that live alone, as this helps towards contributing to the depressive symptoms.
Treatment of Post-Stroke Depression
When considering effective treatment for the condition, one of the key aspects to note is that the treatment approaches do not only seek to deal with the issue of depression but also focus on dealing with the stroke. Stroke is considered as the main contributor to the occurrence of depression; thus, meaning that effective treatment of stroke would play a critical role in ensuring that the survivor can cope with the outcomes to help minimize the risk of depression. Several treatment options are often considered when seeking to treat post-stroke depression. The following are some of the recommended treatment approaches that are utilized in the health care industry today:
Pharmacotherapy
The use of drugs and medication has been considered as one of the viable approaches towards dealing with the underlying issue of post-stroke depression. Some of the key medications that are used as part of the treatment process include Selective Serotonin Reuptake Inhibitors (SSRIs) and Tri-Cyclic Antidepressants (TCAs) (Valiengo, Goulart, de Oliveira, Benseñor, Lotufo, & Brunoni, 2017). The use of these two types of drugs helps in the physical recovery and cognitive improvement of patients after they have suffered a stroke. That means that it becomes much easier for the patients to improve concerning their health care outcomes while ensuring that the drugs help in reducing the incidences of depression. The use of SSRIs and TCAs is recommended, as they both allow for immediate rehabilitation of the patients as a way of improving on the overall outcomes, especially in working towards ensuring that patients can cope with the consequences of stroke.
Cognitive Behavioral Therapy (CBT)
The use of therapy has also been seen as a practical approach through which to deal with the health issue of post-stroke depression. Specifically, it is expected that patients will be taken through cognitive behavioral therapy (CBT) in ensuring that that they well equipped in their bid to deal with some of the underlying impacts associated with stroke (Lewin-Richter, Volz, Jöbges, & Werheid, 2015). In severe cases, the health care professional focus on the use of a pharmacological and therapeutic approach to help achieve the best possible outcomes. A combination of these two approaches has been considered as being somewhat effective in dealing with depressive disorder without stroke. Consequently, this means that their utilization as part of patients suffering from post-stroke depression would serve towards ensuring that they can maximize on best possible health outcomes.
Recovery/Prognosis
The recovery of patients can only be quantified, focusing on several key attributes that have been highlighted to determine the extent to which patients recover from the underlying outcomes associated with the condition. Mood rectification is considered as one of the critical determinants of recovery, considering that it serves towards highlighting that PSD patients have the ability to control their moods in an effective manner (Wei et al., 2015). The clinical signs associated with mood rectification reflects on the fact that patients can ensure that they remain positive regardless of their exposure to stroke. Another key recovery outcome that ought to be considered when determining the impacts associated with the treatment options is improved acceptance of one’s health status after exposure to stroke. Post-stroke patients often find it hard in their bid to coping with the significant changes in their health status, which impacts their interest in life. The treatment approaches adopted expected to ensure that patients improve their abilities to cope with the stress associated with stroke.
Conclusion
According to data presented by the World Health Organization (WHO), the occurrence of the rate of post-stroke depression has increased significantly in the world today, taking into account that approximately 15 million people are diagnosed with stroke annually. The prevalence of PSD is at an average of 31%, which raises serious concerns over the approaches that have been put in place in dealing with the rising number of stroke survivors in the world today. Using the Diagnostic and Statistical Manual (DSM) V tool, the condition is diagnosed as a mood disorder that is considered as being superimposed on another medical condition.
References
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Lewin-Richter, A., Volz, M., Jöbges, M., & Werheid, K. (2015). Predictivity of early depressive symptoms for post-stroke depression. The journal of nutrition, health & aging , 19 (7), 754-758.
Mitchell, A. J., Sheth, B., Gill, J., Yadegarfar, M., Stubbs, B., Yadegarfar, M., & Meader, N. (2017). Prevalence and predictors of post-stroke mood disorders: A meta-analysis and meta-regression of depression, anxiety, and adjustment disorder. General hospital psychiatry , 47 , 48-60.
Paolucci, S., Iosa, M., Coiro, P., Venturiero, V., Savo, A., Angelis, D. D., & Morone, G. (2019). Post-stroke Depression Increases Disability More Than 15% in Ischemic Stroke Survivors: A Case-Control Study. Frontiers in neurology , 10 , 926.
Robinson, R. G., & Jorge, R. E. (2015). Post-stroke depression: a review. American Journal of Psychiatry , 173 (3), 221-231.
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Shi, Y., Yang, D., Zeng, Y., & Wu, W. (2017). Risk factors for post-stroke depression: a meta-analysis. Frontiers in aging neuroscience , 9 , 218.
Valiengo, L. C., Goulart, A. C., de Oliveira, J. F., Benseñor, I. M., Lotufo, P. A., & Brunoni, A. R. (2017). Transcranial direct current stimulation for the treatment of post-stroke depression: results from a randomized, sham-controlled, double-blinded trial. J Neurol Neurosurg Psychiatry , 88 (2), 170-175.
Volz, M., Möbus, J., Letsch, C., & Werheid, K. (2016). The influence of early depressive symptoms, social support, and decreasing self-efficacy on depression six months post-stroke. Journal of Affective Disorders , 206 , 252-255.
Wei, N., Yong, W., Li, X., Zhou, Y., Deng, M., Zhu, H., & Jin, H. (2015). Post-stroke depression and lesion location: a systematic review. Journal of neurology , 262 (1), 81-90.
