Depression, Anxiety, and Brain Injury : It's So Much More Than the Blues

Needless to say for the readers of this blog, I had a stroke. I feel fine one day and mopey the next for whole afternoons. Two weeks pass and then I feel good again for the next two days and mopey the next evening. I used to say it was depression. But it's not. Not even close. 

Depression symptoms may include feelings of sadness, loss of interest in activities that were once contenting, helplessness, sleep problems, and suicidal thoughts or actions. [I said I was suicidal, but I did not even attempt to try killing myself--not even once].

I've heard it said, in its most simplistic definitions, that depression is worrying about the present; anxiety is worrying about the future. But they are related. I mean, how can you worry about the present without worrying about what's coming tomorrow? 

The Stroke Foundation in Australia says it is normal to feel sad or worried after a stroke. I agree with that statement, but I detest the timelines like in the following. 

"If you feel sad, down or miserable for more than two weeks, you may have depression. You may lose interest or pleasure in things you normally enjoy. You may lack energy, have difficulty sleeping, or sleep more than usual. You may find it difficult to concentrate, to solve problems and to keep appointments," the Aussies say. 

"Feeling anxious is normal when we feel under pressure. The feelings usually go away when the stressful situation is over. If anxious feelings do not go away, or if you are anxious for no particular reason, you may have anxiety."

What happened to "all strokes are different"? Like snowflakes, it is often said. In my opinion, it's so much more complicated that that.  

So what does this mean? I'll make it clearer. Stroke has the potential to affect your worth as a human being, questioning your existence and the part you play in it [depression], and make you worry about the future, like about the future, like altering responsibilities, work, relationships, and finances [anxiety]. 

Depression and anxiety--intertwined at one point or, maybe, forever. Depression is most common the first year after a stroke, but it can prolong, along with anxiety which may occur during the same time frame or following each other, or later. Loved ones and caregivers, of course, may experience depression and anxiety as well. (I hear the incantations "every stroke is different" playing somewhere in my brain, for the strokee and all who participate in the care of such).

WedMD says, "Many people who have a stroke or so-called mini-stroke (transient ischemic attack, otherwise known as TIA) become depressed afterward, yet up to two-thirds are not getting ample treatment for their depression."

"A lot of people are not aware of this risk,” Nada El Husseini, MD, Duke University stroke researcher says. “Even if they are feeling depressed, they don’t think it’s relevant.”

However, it is relevant. Depression can affect rehabilitation as well as recovery following a stroke. Chad Miller, MD, an Ohio State University associate professor of neurology and neurologic surgery, says, “Depression needs to be added to the checklist of things that stroke patients [and other brain injuries as well] need to be evaluated for.”

A new study in which Dr. Miller participated, included 1,450 U.S. adults who had a stroke and nearly 400 who'd had a TIA.  

Around 18% of the stroke survivors and about 14% of those who'd had a TIA were depressed three months after. A year after the stroke, 16% were depressed and 13% of those who had a TIA. 

"Depression was more likely to last in people who were younger, were more disabled by their stroke, and who were unable to return to work three months after their stroke," the study says.

The study goes on to say, "Around 70% of people with constant depression weren't being treated with antidepressants at either the three and 12-month mark."

“Each stroke doctor is somewhat aware of this risk, but it may not be one of the priorities,” Miller says. Many stroke specialists focus on addressing risk factors to prevent another stroke from occurring and rehabilitation issues. 

Uh huh. What does that sentence even mean? And who are these stroke specialists?

If you think you have depression and/or its sister, anxiety, like trouble sleeping or feelings of hopelessness, after a brain injury like stroke, you would be better off visiting your primary physician and tell all the symptoms that make you think you have depression and/or anxiety. A trusted doctor may treat your depression/anxiety or refer you to someone who can. 

Remember, stroke affects the essential organ--the brain. The brain is the most complex organ in the body, made up of a complex network of billions of nerve cells called neurons. So the takeaway? One, it is not uncommon to have depression and anxiety after a stroke and two, the feelings you have are your feelings. Don't let anybody diminish them.