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Introduction
As per a new medical study, depressed individuals are at a higher risk of suffering from stroke. This conclusion was arrived at after the analysis of 28 previous studies that encompassed 8,478 stroke cases and 318,000 individuals. This culminated to the conclusion that depression could be linked to an increase in stroke risk of about 45% and fatal stroke risk of 55%. Essentially, it could be linked to a higher ischemic stroke risk of 25%. The major explanations behind the connection encompass inflamed nervous and endocrine systems, a poor lifestyle characterized by smoking, unhealthy diets, poor health habits and lack of medication taking, possession of various medical conditions that increase stroke risks as well as antidepressant medication. Inherently, the link between depression and stroke can be analyzed on the basis of post-stroke depression that is identified as the major neuropsychiatric corollary of stroke (1). This depression negatively impacts on survival, functional recovery and cognitive function.
The Psychological, Biological and Social Treatments for Post Stroke Depression
Epidemiological studies ascertain that close to 30% of stroke patients are affected by mood depression at the late or early stroke stages. In treating post stroke depression, various psychological, biological and social treatments are utilized.
Psychological Treatment
Research ascertains that various psychological treatments can be utilized in the effective treatment of post stroke depression, especially in the early stages after stroke. According to surmountable psychological research, such interventions can be utilized in the prevention and treatment of post stroke depression (5). Cognitive behavior therapy has been identified, as the most successful psychological treatment of post stroke depression, but additional research should be conducted to identify the cognitive behavior therapy most appropriate for younger and older victims, those with cognitive communication difficulties as well as those living in institutions.
The cognitive behavior therapy aids the patients to have a clear understanding of the relationship that exists between their emotions, behavior, physical symptoms and thoughts. This is because it relies on the change of maladaptive thinking that culminates into a positive effect on behavioral change. In addition to Cognitive Behavior Therapy, neuropsychological assessment and cognitive rehabilitation encompass additional effective treatments for post stroke depression (5). Under Neuropsychological assessment, the cognitive deficits’ nature and extent are measured through psychometrically valid instruments that can effectively monitor any changes effected on cognitive functioning. This culminates into the identification of the major depression difficulties the patients face. This is followed by cognitive rehabilitation, in accordance to the difficulties.
Social Treatments
Psychological research ascertains the fact that post stroke depression is linked to loneliness and social isolation. Research identifies interpersonal psychotherapy, as the most effective post stroke depression social treatment. This is because; it encompasses the use of interventions on the basis of relationship and social functioning, with the aim of eliminating loneliness and social isolation. In this case, the therapist aids the patient to identify the problems that infringes upon his or her social and relationship functioning. Based on these causes, various interventions are identified and applied in enhancing the positive social and relationship functioning of the patient. Building strong relationships will culminate into the elimination of loneliness, while enhanced social functioning culminates into the elimination of social isolation (2). Another effective post stroke depression social treatment encompasses psychosocial behavior therapy that does not function alone, but functions effectively when combined with anti depressants. Music therapy encompasses another social treatment, as it elicits positive impacts on post stroke depression.
Biological Treatment
The biological treatment of post stroke depression encompasses the use of omega-3 fish oil, vitamin B therapy, drug therapy of medication use and electro-convulsive treatment. Due to the sharing of similar cardiovascular risk factors between stroke and depression, research ascertains that lower levels of vitamin B culminates into a higher risk of developing depression, especially after a stroke (3). This culminates into the conclusion that a higher intake of vitamin B by stroke patients can culminate into the prevention and treatment of post stroke depression. Drug therapy or medicine use in treating post stroke depression is based on the fact that depression culminates from the imbalance of cerebral serotonergic and noradrenergic systems.
In this case, the use of various antidepressants has been associated with the treatment of depression as well as the reduction of its symptomatology. Heterocyclic antidepressants aid in blocking the increased intake of norepinephrine and serotonin; hence, culminating into the prevention and treatment of post stroke depression. The most common heterocyclic antidepressants include maprotiline, doxepine, trazadone, imipramine, amitriptyline and desipramine. Selective Serotonin Reuptake Inhibitors encompass additional effective biological treatments for post stroke depression. These inhibitors aid in blocking the reuptake of serotonin selectively, but do not block norepinephrine reuptake (4). They are effective in treating anxious depression, whose characteristic include trepidation, restlessness, insomnia, anxiety and hostility. The success of this treatment is viewed after 12-18 weeks of administration. This type of biological treatment is highly preferred by most patients, owing to the fact that it encompasses minimal side effects, as compared to those of heterocyclic drugs. The most common inhibitors include placebo and fluoxetine.
Another effective biological treatment encompasses adjunctive light therapy. This treatment is effective for both non-seasonal and seasonal depression. This type of treatment only becomes effective after it has been administered for more than four weeks. An additional biological treatment for post stroke stress encompasses Selective Noradrenalin Reuptake Inhibitors (3). These encompass antidepressant types tasked with the role of inhibiting the reuptake of noradrenaline. They are effectively applied in the treatment of retarded depression that includes such symptoms as hypomimia, hyponinesis, anergia, slowness of action initiation and lethargy. Such Gamma Aminobutryric Acid compounds as nefiracetam are utilized in treating post stroke depression by enhancing glucose utilization, blood flow and neurotransmission.
Psychological research ascertains that the conduction of considerable research is required before the administration of psychological and social treatments of Post stroke depression. For this reason, biological treatments encompass the most effective and recommended treatments for post stroke depression (3). This is because a variety of these are available and a patient and his or her physician, can choose the best biological treatment based on that treatment’s side effects and their considerable effects on the patient’s health.
Summary
As ascertained by the research conducted in this paper, the best treatment for post stroke depression encompasses biological treatments. This is highly linked to the case of the 69 years old female that underwent through a cerebrovascular accident in 1990. This is because after the development of Post stroke depression she was put under various biological medications. Alprozolam at 0.25 mg twice a day which encompasses a Gamma aminobutryric acid compound aids the patient by enhancing her psychoactivity (1). This helps in the reduction of anxiety disorders linked to post stroke stress. Her use of Zopiclone 7.5 g in morning can be identified as Selective Serotonin reuptake inhibitor.
This is because it aids in the treatment of insomnia, a major characteristic of post stroke depression. Venlafaxine encompasses a Serotonin Norepinephrine Reuptake Inhibitor that aids in inhibiting the uptake of norepinephrine and serotonin as well as dopamine, whose increased uptake culminates into a higher level of depression. Atorvastatic encompasses a drug utilized in reducing the inflammatory factors that culminate into strokes (2). This prevention of stroke is effective in ensuring that post stroke depression does not affect the patient. These biological treatments can be combined with the psychological and social treatments to enhance the health outcomes of the 69 year old female.
Cognitive behavior therapy and interpersonal psychotherapy can be applied to enhance the reduction of the anxiety disorder on the part of the patient. Essentially, it can be utilized to reduce insomnia. Inherently, psychosocial behavior therapy can be combined with the antidepressants the patient is taking to ensure that she overcomes the post stroke depression she has been suffering under since 1990 (4). The reason why she has been unable to overcome post stroke depression might lay on the type of treatment she has been undergoing. She should therefore try the other treatment options available for Post stroke depression.
Bibliography
- Capaldi VF, Wynn GH. Emerging strategies in the treatment of post stroke depression and psychiatric distress in patients. Psychology Research and Behavior Management 2010; 3: 109-118
- Geyer J. Stroke: A practical approach. Philadelphia: Wolters Kluwer Health; 2007.
- Harrington C, Sulloway S. The diagnosis and treatment of post stroke depression. Medicine and health 1997; 80(6):183-189
- Paolucci S. Epidemiology and treatment of post stroke depression. Neuropsychiatric Disease and Treatment 2008; 4(1): 145-154
- Watkins CL, French B. Psychological intervention post stroke. Stroke 2009; 40: 2951-2952
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