A variety of emotional and behavioural disorders may develop following stroke. Depression, the most common emotional disorder, may affect up to 40% of all patients with stroke. Depression affects every aspect of a person’s life, such as their body, emotions, thoughts and mood. It is much more complex than simply “feeling blue” and is characterized by a persistent and pervasive feeling of sadness or hopelessness. Depression can also be associated with a combination of the following symptoms: poor appetite and weight loss (or conversely weight gain), sleep disturbances (insomnia or hypersomnia), constipation, psychomotor retardation (or conversely agitation), difficulties with concentration and thinking, withdrawal from interpersonal contact, feelings of guilt or self-blame, diminished interest or pleasure in most or all activities, and recurrent thoughts of death or suicidal ideation. Depression can occur early after stroke or in the years following. Detection of post-stroke depression is often overlooked so it is important to use reliable measures when evaluating the patient after stroke.
Various interventions exist for post-stroke depression and are reviewed in this module. These include psychosocial support programs (individual, group or community), cognitive-behavioral therapy, multimodal interventions (exercise + psychoeducation), neuro-linguistic programming therapy, speech therapy, patient-centered counselling, art therapy and wellness therapies (e.g. relaxation therapy, forest therapy, Yoga, Tai Chi, meditation, enriched environments therapy).
Note: Extensive research has investigated the benefits of various drugs such as heterocyclic antidepressants, psychostimulants, and selective serotonin reuptake inhibitors (SSRIs) to treat post-stroke depression. Drug studies are not covered in this module.
Authors*: Tatiana Ogourtsova PhD OT, Annabel McDermott OT, Chelsea Hellings BA, Katherine Salter BA, Sanjit Bhogal MSc, Robert Teasell MD, Norine Foley BASc, Mark Speechley PhD, Elissa Sitcoff BSC, BA, Anita Menon, MSc
Evidence reviewed as of before 04-01-2018