Stroke is a leading cause of death in the United States and around the world and one out of every cardiovascular disease-related death is due to stroke. Depression is most likely to occur after a stroke and not only because of the emotional or psychological impact it may have on the individual, but rather due to neuroinflammatory processes that occur during and after a stroke. And post-stroke depression is usually associated with poor recovery and quality of life.
Post-Stroke Depression
Although depression after a stroke is so common, it many times goes unrecognized and untreated. It’s estimated that over 33% of stroke survivors experience symptoms of depression. People who have post-stroke depression have poorer neurological outcomes and greater financial costs. Recovering from a stroke while dealing with depression may be affected by a number of factors such as age, severity and location of the stroke, and health, functional and cognitive status. Other factors include genetics, inflammation, nervous tissue damage, disturbance of neural networks and changes in neurotransmitters.
Post-Stroke Depression and Inflammation
For some time now, researchers have identified inflammatory markers associated with depression. People with depression, for example, have an increase in proinflammatory cytokines, which enter the brain and influence neurotransmitters involved in depression, such as the serotonin system. There may also be an increase in interleukin-6 (a chemical that causes inflammation) leading to depression through its impact on the hypothalamic-pituitary-adrenal axis (HPA Axis) or metabolism of neurotransmitters.
Certain Antidepressants Can Help
It is widely believed that the first line of antidepressant treatment is the use of SSRIs or selective serotonin reuptake inhibitors. These include Celexa, Prozac, Paxil and Zoloft all of which work to restore the balance of serotonin which is disrupted by inflammatory processes. The medications are generally well-tolerated by the general population and produce mild to no side effects.
Two other classes of antidepressants have shown positive effects in reducing or preventing depression after a stroke when taken up to 12 months. These include tetracyclic antidepressants such as Remeron, and SNRIs or selective norepinephrine reuptake inhibitors like Savella.
Vitamins That May Help
Besides antidepressants and of course, some form of psychotherapy or counseling, certain vitamins may be helpful in managing post-stroke depression. Vitamin B12, B6 and folate break down homocysteine which is a naturally occurring amino acid and is harmless at low levels. At high levels, it can do a lot of cardiovascular damage. Low levels of vitamin D have been shown to be a risk factor for post-stroke depression and is generally recommended after a stroke has occurred. It provides neuroprotection by reducing oxidative stress (free radicals) and inflammation. Retinoic acid, a metabolite of vitamin A, acts like vitamin D in reducing oxidative stress and inflammation.
Final Thoughts on Stroke, Depression and Inflammation
Stroke is a leading cause of death and post-stroke depression is more of the norm rather than the exception. It’s valuable to understand that symptoms of depression aren’t just due to one’s emotional reaction to having a stroke, but are instead due to bioactive and chemical changes associated with inflammation. Talk therapy might help with one’s coping skills, but certain antidepressants and vitamins may get to the root of biochemical depression – inflammation.