Depression after stroke: a neglected problem

People who have had a stroke and the people who are close to them need more support in order to manage the consequences of stroke. As well as the physical disabilities, the psychological burden is difficult to cope with. It is not only stroke patients who become depressed: their friends and relatives often become depressed too. The German Institute for Quality and Efficiency in Health Care (IQWiG) has now assessed research on treatments for depression after a stroke. They found that using antidepressants after a stroke does not have the effect it is expected to have. Because of their adverse effects and interactions with other drugs, antidepressants should only be used with caution.

The success of treatment depends on motivation and good support

It is often difficult, even for doctors, to know whether people are feeling down after having a stroke or whether they have slid into a depression which needs treatment.

Appropriate treatment is not only important for the person's mental health; being depressed can delay their physical recovery too. There is not enough awareness about this problem. The Institute has therefore published information about this for patients, their friends and relatives today on InformedHealthOnline.org.

"The success of stroke rehabilitation also depends on patients playing an active role in their own treatment," says the Institute's Director, Professor Peter Sawicki. "Rehabilitation is demanding, requiring a lot of patience and motivation. If people become depressed, it is very difficult for them to have the necessary motivation."

For treatment to be successful in the long term, it is important that doctors, nurses, occupational therapists, physiotherapists, patients, their relatives and friends work closely together. Occupational therapy and physiotherapy can help people restore their physical abilities and regain more independence. Research has shown that intensive support like this can also help with depression.

Antidepressants are not as effective as hoped and increase the risk of drug-drug interactions

Scientific studies have suggested that antidepressants may generally be less effective in the treatment of depression after a stroke. Because these drugs can have adverse effects and may influence the effect of other drugs, researchers urge caution in the use of antidepressants.

Professor Sawicki: "Psychotropic drugs can have adverse effects and cause drug-drug interactions, particularly in older people, because they often take several drugs at the same time. Many questions remain unanswered. For example, not enough is known about how much antidepressants influence the risk of falls and seizures." People who have certain stroke-related disabilities, such as difficulty speaking or understanding, were not included in many trials.