Post stroke depression

Post-stroke depression (PSD)

It is considered as one of most frequent and important neuropsychiatric consequence of stroke..This condition can produce an adverse effect on cognitive functionand functional recovery and survival of the patient. post-stroke depression as “mood disorder commonly occur due to stroke having depressive features, major depressive-like episodes, manic features, or mixed features. Approximately one-third of stroke survivors experience major depression.
there are two types of depressive disorders associated with cerebral ischemia:major depression, which occurs in up to 25% of patients; and minor depression, as a depressed mood or loss of interest and at least two but fewer than four symptoms of major depression. Minor depression occurs in up to 30% of patients following
strokethe course of the depression generally after stroke is for 1-2 years, however, it was also noted that in few cases depression becomes chronic and may persist more than 3 years following stroke . On the other hand, minor depression appeared to be more variable, with both short term and long term depression occurring in these
patients .



what cause post stroke depression

the depletion of monoaminergic amines occurring after stroke play a role in post stroke-depression. There may be point that norepinephrinergic and serotonergic nuclei send projections to the frontal cortex and arc posteriorly,
running through the deep layers of the cortex, where they arborize and send terminal  projections into the superficial cortical layers. These norepinephrinergic and serotoninergic pathways are disrupted in basal ganglia and frontal lobe lesions – sites that are shown to be associated with post stroke depression.
Most of the patients donot have any history of depression before stroke Approximately 20 % will have a prior history.


Risk for Dependency
Most of the patients of the stroke who attain dependency are who become older or suffering from major health problems or severely depressed rather than those who are younger free from any health problem or less depressed , If
the.treatment and improvement of post-stroke depression does not directly influence recovery, it is extremely important for depression to be identified and treated, since it is associated with other health and social problems.”individuals who remain depressed three months after a stroke are more likely to have decreased functional
capabilities than those whose depression was successfully treated. Functional capabilities include getting dressed, feeding oneself, and accomplishing other tasks.

These capabilities increased significantly in those individuals who were treated for depression.”Post-stroke depression often impacts quality of life after stroke more than even functional impairments. Since it is treatable with common medications, cognitive behavioral therapy and exercise .Post stroke depression is commonly associated with higher levels of disability and low social support. Rehabilitation must not only focus on the physical recovery of post-stroke patients but also address mental health. Anxiety seems to get better over time, whereas untreated depression
remains an on-going burden to all persons concerned, patients and family. The type of rehabilitation therapies such as physical therapy, occupational therapy and speech therapy not only treat the post stroke depression , their treatment is basically treated with the help of anti depressant medications.



Some of the symptoms of a stroke
stroke is a loss of blood supply to a region of the brain, caused usually
by the formation of a clot within an artery in the brain or by a blood clot, usually
from the heart, breaking off and traveling up the artery into the brain. These are
thromboembolic strokes.

There are also strokes due to bleeding inside the brain,
called hemorrhagic strokes. The most common place for a stroke to occur is in the
distribution of the middle cerebral artery. The middle cerebral artery supplies much
of the frontal, temporal, and parietal lobes of the brain as well as the subcorticol

The symptoms produced by middle cerebral artery blockage include
a loss of ability to move the arm or the leg on the opposite side of the body. So, if
the left side of the brain suffers a stroke, the right side of the body shows physical
weakness. Another common symptom of stroke is loss of sensation, that is, sensation
on the opposite side of the body. A feeling of numbness on the right side of the body
may be the result of a left middle cerebral artery infarction or blockage. Another
common symptom that occurs with stroke is loss of language ability. Language is
predominantly localized to one side of the brain, which we refer to as the dominant
hemisphere. In the great majority of patients, the dominant hemisphere is the left
hemisphere. If a stroke occurs in the dominant hemisphere in the frontal area of
the brain, the patient will lose the ability to produce language. If a stroke occurs in
the posterior portion of the dominant hemisphere where the temporal and parietal
lobes come together, the patient will lose the ability to comprehend language that is
spoken to them. If a patient loses the ability to comprehend language and to produce
language with a very large middle cerebral artery stroke, we refer to that as a global
aphasia. There are quite a number of other symptoms that may be produced by stroke,
including the ability to see on one side of the body, the ability to swallow or to move
the tongue in a normal way.

Some of the signs of depression
In patients who have had a stroke, the
symptoms of depression include a sad mood, loss of interest or enjoyment in usual
activities, loss of energy, difficulty with concentration, decreased appetite with
weight loss, sleep disturbance (particularly waking during the middle of the night
and having difficulty getting back to sleep), a feeling of self-blame or guilt, feelings
of hopelessness about the future, a slowing of the thought process with slowing of
movement and thinking, and thoughts of death or suicide. Check this site for vitamin b complex depression.