Depression after stroke – including family improves outcomes

July 13, 2018

Stroke and rehabilitation are hard things for patients and their families to go through. They can be traumatic and isolating and up to half of patients battle post-stroke depression (PSD) as they recover. Family and caregivers also experience stress, and many of them become clinically depressed as well. So, no matter where you are on your journey, take a moment to breathe deeply and congratulate yourself. After all, you’ve made it this far, and you are still fighting! And while no one can know exactly what you’re feeling or exactly what you’re going through, you are not alone. There is a therapy community committed to supporting your recovery and treating you with respect and compassion.

There is also a research community committed to expanding what is possible to bring you better, more effective treatments. As part of this effort, researchers recently reviewed the best available studies to determine what works for patients and families. If you are battling depression, take a look at their findings and discuss them with your doctor or therapist.

Review about depression

Researchers in Australia and Qatar looked at studies about depression in stroke patients or their families. The studies had to include data on the effectiveness of treatments or approaches designed to prevent, diagnose, or treat depression. After sifting through thousands of articles, the team selected 25 studies involving 3739 subjects. Then the researchers looked for the most and least effective strategies in these articles.

Can depression be treated successfully?

Effective treatments are multi-component, involving the patient and family in goal setting, problem solving, and skill development. They also facilitate coordination of different aspects of patient care and progress tracking. They are structured but individualized, assessing the appropriateness of a wide variety of standard services at each phase of rehabilitation. And they are timely, beginning as soon after the stroke event as possible. If a patient or family member does experience depression, a long-duration, high-contact therapy plan is advisable.

Multi-component — confusing word, a valuable concept

The most effective programs for both rehabilitation and depression prevention were multi-component. They involved a strategy with multiple facets. Patients and caregivers learned how to solve problems, set goals, and acquire the skills to reach them. This approach increases patient progress during rehabilitation and continues to be useful after the patient goes home. This approach is also multi-person that involves patients and family members/caregivers. And everyone benefits.

Coordinated care

The medical system in the U.S. is very complex. Patients and families need help accessing available social and rehabilitative services. And they also need help coordinating the various parts into an effective course of treatment. Coordinated care also makes it easier to track the progress and well-being of patients and families. This, in turn, makes it easier to get people the help they need, including anti-depressants and counseling.

Structure and flexibility

Patients and families are more likely to get effective and appropriate care in a structured, but flexible, treatment program. One of the most successful programs in the review used lists of available services at transition points in treatment. Patients and families didn’t need every assistance, but considering all angles is essential in creating an effective individualized plan. And better rehabilitation leads to less depression and to earlier and more effective treatment when needed.

Early implementation

We are sure you have heard this before, but it’s important. The earlier you start a treatment plan, the more effective it will be. It’s best to plan your campaign while you are still in the hospital and begin it as soon as you leave.

Duration and frequency — more is more

This review also found that effective depression treatment takes at least three months of weekly face-to-face sessions. If you are in emotional pain, there is absolutely no reason to skimp on therapy or other kinds of treatment. Effectiveness is very much tied to longer duration and higher frequency.

Less effective approaches — beware!

The review also identified three less effective approaches to avoid. Unstructured rehabilitation is non-standardized. Individual team members suggest treatment options based on their knowledge and experience. Unstructured programs were generally less effective than structured ones by most measures, including dealing with depression. Also, programs with a limited number of face-to-face visits did little to help PSD. And programs that relied on assistance delivered over the phone also had a poor record. Despite one highly effective plan with a phone support component, the odds are better with in-person treatment.

 The bottom line

Although the review did not identify a magic bullet to treat depression, research on that front continues. But patients experience less depression when they have effective treatment programs and are making progress. And family members do better when they are involved and can help and support the patients.

 

The lead author of this publication is Dr. Vallury, University Department of Rural Health (UDRH), University of South Australia, Whyalla, Australia.

Editorial note:

If you are battling depression after stroke, take a look at these findings and discuss them with your doctor or therapist.

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