Dealing with Post-Stroke Depression

Sheryl Martin-Schild, MD, PhD, FANA, FAHA

Stroke is the number 5 cause of death in the United States and the number 1 cause of adult disability. Disability after a stroke can be mild (e.g. slight facial droop) to severe (e.g. completely bed-bound) depending on size and/ or location of the infarct. Strokes can also lead to personality changes, increased anxiety, impulsivity, or apathy.

What is post-stroke depression?

Depression after stroke is common, affecting about 1 in 5 people. It is normal to feel frustrated and upset with an inability to perform regular tasks, like dressing yourself or speaking. Stroke potentially changes chemicals in the brain, promoting depression. Depression is highly associated with more severe physical impairment and less improvement after stroke, compared with non-depressed patients with stroke, and can become a barrier to improving with therapies.

Common symptoms of depression:

  • Feeling sad, hopeless or “empty”
  • Feeling worthless and helpless
  • Feeling irritated, anxious, angry
  • Slowed processing, impaired concentration, poor memory
  • Unexplained aches and pains
  • Poor energy
  • Loss of interest in pleasurable activities
  • Sleeping too much or too little with trouble getting or falling asleep
  • Eating too much or not enough
  • Suicidal thoughts

Feelings of grief and loss are normal after a stroke. Many of the listed symptoms are common during the adjustment phase after stroke. If symptoms accumulate or worsen over time, you need medical attention.

Can post-stroke depression be treated?

Depression is largely treatable with medications and therapy. It is important to seek treatment as if left unmanaged, it can lead to worsening of other conditions that may exist, like sleep problems, pain, continence issues, and nutrition. Treatment of depression is associated with lower death rates after stroke. Antidepressants given to stroke patients, even those without depression, may lead to greater improvement in cognition, communication, and motor function than placebo during rehabilitation. Other ways to prevent or treat depression include:

  • Learning more about stroke
  • Document progress in rehab
  • Talk about your feelings with family and friends
  • Stay as active as possible with prior hobbies
  • Abstain from alcohol.

Depression should not be confused with pseudobulbar affect (PBA), which is characterized by inappropriate emotional responses like laughing at a funeral, or crying without cause. Treatment of PBA is different than treatment for depression.

If you or a loved one have symptoms of depression, please communicate this with your doctor. If there are thoughts of suicide, immediate attention is needed.

Lastly, it is important to remember the common signs of a stroke. Call 911 immediately if you suspect a stroke is occurring. If all of a sudden you cannot do something you used to be able to do, or you experience the worst headache of your life, think stroke.

Click here to learn more about stroke and prevention.

Click here to learn more about Touro’s Certified Primary Stroke Center.

Recovering after Stroke Seminar

Thursday, May 31
12pm to 1pm
Presidents Room
1401 Foucher Street, 2nd Floor
New Orleans, LA, LA 70115

Join Touro Neurologist Digvijaya Navalkele, MD and the Touro Rehabilitation Center for an informative seminar on life after stroke. If you or someone you love has suffered a stroke, you may wonder what lies ahead. A stroke can cause problems with speech, vision, memory, balance, or coordination. It can leave part of the body weakened or paralyzed, among other physical problems.

It may help to know that rehabilitation can help people regain life skills and learn new ways to do tasks. We’ll share resources and tips for stroke recovery, including navigating depression and emotional support. Plus learn steps to prevent stroke recurrence and improve brain health.

A light lunch will be provided.

Click here to register or call 504-897-8500.

Dr. Sheryl Martin-Schild, MD, PhD, is a New Orleans native and has spent the majority of her training and career in New Orleans. Prior to joining Touro, Dr. Martin-Schild served as an Associate Professor of Neurology and Director of the Stroke Program at Tulane University School of Medicine for eight years where she developed and award winning comprehensive stroke center.  She currently also serves as the Stroke Medical Director for the New Orleans East Hospital.  Dr. Martin-Schild enjoys mentoring medical students and residents in healthcare outcomes research in acute stroke. Her number one priority is her patients and making sure they receive the best care during and after their hospital stay. Dr. Martin-Schild is the State Medical Director for Stroke of the Louisiana Emergency Response Network (LERN) and enjoys traveling to facilities throughout Louisiana, educating healthcare providers and the public on stroke risk factors, prevention, and acute treatment.

Would You Recognize a Stroke?

Sheryl Martin-Schild, MD, PhD, FANA, FAHA

Stroke is the 5th leading cause of death in the United States, ranked behind diseases of the heart, cancer, chronic lower respiratory disease, and unintentional injuries/accident. Stroke, also called “brain attack”, occurs when blood flow to the brain is disrupted, which is caused either by a blood clot blockage to one of the blood vessels in the brain (ischemic stroke), or when a blood vessel in the brain bursts, spilling blood into surrounding tissues (hemorrhagic stroke).

A stroke is an emergency situation, and it’s important to know the signs of a stroke and get help quickly. Treatment is most effective when started right away. With each minute that passes, the effectiveness of treatment is reduced.

Who can experience a stroke?

Anyone can be a victim, but certain people are more likely to have a stroke. These include:

  • Older adults
  • African-Americans
  • Heart disease
  • People with type 2 diabetes
  • People with high blood pressure or high cholesterol
  • Cigarette smokers
  • People who drink too much alcohol
  • Individuals with a history of stroke

What are the symptoms of a stroke?

These are the five most common symptoms of stroke:

  • Sudden weakness or numbness of the face, arm or leg, especially on one side of the body
  • Sudden confusion, trouble speaking or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden, severe headaches with no known cause (for hemorrhagic stroke)

The key word in each of the warning signs is sudden. The sudden occurrence of any of these symptoms could possibly indicate a stroke and should prompt the individual to seek immediate medical attention.

How long should you wait before getting help?

You should think F.A.S.T. and call 911 immediately. F.A.S.T. stands for:

F – Face drooping. One side of the face is drooping or numb. If a person smiles, the smile is uneven.

A – Arm weakness.  One arm is weak or numb. When the person lifts both arms at the same time, one arm may drift downward.

S – Speech difficulty. You may see slurred speech or difficulty speaking. The person can’t repeat a simple sentence correctly when asked.

T – Time to call 911. If someone shows any of these symptoms, call 911 right away. Call even if the symptom goes away. Make note of the time the symptoms first appeared.

Even if you’re not experiencing all of the symptoms, you could be having a stroke. It’s also important to note the time of the first symptom. This information is important and can affect treatment decision.

Common stroke symptoms not covered by FAST include visual changes, dizziness/loss of balance, isolated leg weakness, and severe headache.  Any of these symptoms could be due to stroke.

Click here to learn more about stroke and prevention.

Click here to learn more about Touro’s Certified Primary Stroke Center.

Dr. Sheryl Martin-Schild, MD, PhD, is a New Orleans native and has spent the majority of her training and career in New Orleans. Prior to joining Touro, Dr. Martin-Schild served as an Associate Professor of Neurology and Director of the Stroke Program at Tulane University School of Medicine for eight years where she developed and award winning comprehensive stroke center.  She currently also serves as the Stroke Medical Director for the New Orleans East Hospital.  Dr. Martin-Schild enjoys mentoring medical students and residents in healthcare outcomes research in acute stroke. Her number one priority is her patients and making sure they receive the best care during and after their hospital stay. Dr. Martin-Schild is the State Medical Director for Stroke of the Louisiana Emergency Response Network (LERN) and enjoys traveling to facilities throughout Louisiana, educating healthcare providers and the public on stroke risk factors, prevention, and acute treatment.

Understanding Stroke

Be a stroke hero

Royce Dean Yount, M.D.

In honor of American Stroke Awareness Month, the American Heart Association and American Stroke Association wants everyone to be a stroke hero. Anyone can be a hero by controlling their blood pressure and other risk factors. Knowing your risk factors is the first step in stroke prevention. The good news is 80% of strokes can be prevented.  Also, 3 out of 4 people who suffer first strokes have high blood pressure, which is #1 controllable risk factor.

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World Stroke Day

What You Need To Know About World Stroke Day

Kodi Craft, RN, BSN, MSHCM

WORLD STROKE DAY, established by the World Stroke Organization in 2006, is observed worldwide on October 29 to underscore the serious nature and high rates of stroke, raise awareness of the prevention and treatment of the condition, and ensure better care and support for survivors.

About 800,000 people in the United States Have a stroke every year. Stroke is the leading preventable cause of disability, and the number 5 cause of death in the United States, claiming 130,000 lives per year. Acting FAST at the first sign of a stroke can help save a life.

How much do you know about stroke? Find out by taking our online quiz here.

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Stroke Awareness Month

Learn Stroke Warning Signs and Save a Life

Mary Genovese RN, MSN, CCRN

Each May, during National Stroke Awareness Month, it is a good time to reeducate our community on steps they can take to prevent stroke and warning signs to help identify stroke early. Strokes are the 4th leading cause of death in the U.S. and a leading cause of long-term disability. Strokes kill more than 137,000 Americans each year but most people do not consider stroke a serious health concern.

The good news is up to 80% of strokes can be prevented through living a healthy lifestyle.

Click here to learn about preventing stroke in women.

stroke characteristics

What is a Stroke?

Stroke occurs when blood flow to the brain is disrupted. Disruption in blood flow is caused when either a blood clot blocks one of the vital blood vessels in the brain (ischemic stroke), or when a blood vessel in the brain bursts, spilling blood into surrounding tissues (hemorrhagic stroke).

The brain needs a constant supply of oxygen and nutrients in order to function. Even a brief interruption in blood supply can cause problems. A loss of brain function occurs with brain cell death. This may include impaired ability with movement, speech, thinking and memory, bowel and bladder, eating, emotional control, and other vital body functions.

Recovery from stroke and the specific ability affected depends on the size and location of the stroke. A small stroke may result in problems such as weakness in an arm or leg. Larger strokes may cause paralysis (inability to move part of the body), loss of speech, or even death.

Stroke Warning Signs

According to the National Stroke Association (NSA), it is important to learn the 3 R’s of stroke:

  • Reduce the risk.
  • Recognize the symptoms.
  • Respond by calling 911 (or your local ambulance service).

Stroke is an emergency and should be treated as such. The greatest chance for recovery from stroke occurs when emergency treatment is started immediate

Reducing Stroke Risk

You can reduce stroke risk by controlling treatable diseases that increase stroke risk:

  • High Blood Pressure (if left untreated, high BP can weaken blood vessels and damage major organs such as the brain)
  • Atrial Fibrillation (AF) (resulting irregular heart beat can lead to blood clots that can are carried to the brain, increasing stroke risk)
  • High Cholesterol (High levels of cholesterol in the bloodstream can clog arteries and lead to stroke or heart attack)
  • Diabetes (People with diabetes are up to 4 times more likely to have a stroke than someone who does not have the disease)
  • Atherosclerosis (the progressive buildup of plaque in artery walls. It can clog arteries and block the flow of blood to the brain)

Lifestyle changes:

  • Stop smoking and/or use of tobacco; smoking doubles your risk of stroke.
  • Limit use of alcohol, drinking large amounts may increase risk of stroke.
  • Obesity and excess weight increase risk for stroke.

Stroke Symptoms and Warning Signs

Learn the many warning signs of a stroke. Act FAST and CALL 9-1-1 IMMEDIATELY at any sign of a stroke. Use FAST to remember the warning signs:

Stroke symptoms

FACE: Ask the person to smile. Does one side of their face droop?

ARMS: Ask the person to raise both arms. Does one side drift downward?

SPEECH:  Ask the person to repeat a simple phrase. Is their speech slurred or strange?

TIME:  If you observe any of these signs, call 9-1-1 immediately.

Stroke symptoms include:

  • SUDDEN numbness or weakness of face, arm or leg – especially on one side of the body.
  • SUDDEN confusion, trouble speaking or understanding.
  • SUDDEN trouble seeing in one or both eyes.
  • SUDDEN trouble walking, dizziness, loss of balance or coordination.
  • SUDDEN severe headache with no known cause.

Genovese, MaryMary Genovese RN, MSN, CCRN is AVP of Med Surg/Critical Care at Touro Infirmary. Throughout her 40 years of nursing, Mary has served various leadership and management roles in telemetry, coronary care and other specialties. Mary is a member of the American Association of Critical Care Nurses (AACN), American Nurses Association, and was inducted into Nursing Honor Society, Sigma Theta Tau, in 2008. Mary has maintained Certification in Critical Care Nursing (CCRN) from 1989 to present, and has been recognized as a Great100 Nurse (2000) and City Business Woman of the Year (2009). Mary earned her Bachelor of Science in Nursing from Louisiana State University School of Nursing in 1978 and earned her Master of Nursing in Healthcare Systems Management in 2008.