Post Stroke Depression (PSD); the struggle is real
I was sitting in Starbucks with a good friend of mine from church talking about life and such (we’ll call him John). John’s a black male approximately 50 years old. He’s a realtor, a very good realtor with many clients. He’s done a great job building up a name for himself in the real estate industry around Dallas. John was a healthy guy it seemed, solid as a rock! However, you just never really know what’s going on behind the scenes do you? The next time I would see John would be six months later being pushed in a wheelchair by his wife with only half his body working. I was in complete shock. John had had a stroke.
Stroke, also known as cerebrovascular accident, and most recently referred to as “brain attack” is the third leading cause of death in the United States. With the number of strokes occurring each year nearing 800,000, the death toll has risen to approximately 135,000 deaths annually (McCance & Huether, 2015). Strokes can be either be classified as ischemic or hemorrhagic and then sub-classified into different types of ischemic strokes (Bogiatzi, Hackam, McLeod, & Spence, J. D., 2014)
Why did I mention the fact that my friend John was a 50 year old black man that seemed healthy? Well, because hypertension is also known as the silent killer. It is EXTREMELY common among black males and is also the number one risk factor for suffering a stroke. I also have a lot of black guy friends who I care very much about and I want them to be aware of the dangers of not getting your blood pressure in check.
Although hypertension, highlighted by McCance & Huethner (2015), is the number one risk factor for suffering a stroke, others include hypercholesterolemia, heart disease and atrial fibrillation. Furthermore, there are many risk factors that could be corrected by a change in lifestyle. Among these are poor diets, physical inactivity, obesity, cigarette smoking, and excessive alcohol abuse (Hankey, 2017). For this reason, a high priority should be placed on education and lifestyle modification in patients with these behaviors.
Disability resulting from stroke can be mild or severe depending on the severity of the stroke and can at times require extensive physical therapy to regain full or partial function. Loss of physical or cognitive function can have a profound impact on the lives of stroke victims and their families. Approximately 50% of all stroke victims annually suffer severe consequences that require specialized care (Alajbegovic, 2014).
It is because of the loss of function and/or cognition that cause many patients to suffer from Post Stroke Depression (PSD). PSD occurs in approximately 30-35% of stroke patients and is associated with negative outcomes, including reducing the success of physical rehabilitation, limiting independence, less social interaction, inactivity, and increased risk of mortality (Park et al., 2015).
I remember seeing John for the first time in that wheelchair. He was not the same guy and I’m not talking physically. John was emotionally and psychologically different. He wasn’t the loud boisterous vibrant guy I had spent my Saturday afternoon with chatting it up over a coffee. He was broken. I became emotional. I hated to see this.
PSD has been classified as either Early or Late Onset. Early Onset PSD occurs within the first three months and predictors in these populations include female sex, smoking and mild global cognitive impairment. Late Onset PSD occurs after one year and is associated with smoking and stroke recurrence (Shi et. Al, 2015).
In order to facilitate a better outcome for stroke patients, it is important as nurses and nurse practitioners to recognize the behaviors consistent with depression as early as possible in post stroke patients. According to Cojocaru (2014), care should include multi-therapeutic therapies such as monitoring of patient’s moods, anti-depressant pharmacotherapy, psychiatric referrals, and a focus on secondary prevention of stroke since recurrent strokes result in Late Onset PSD.
I recently saw John and his two daughters. He has begun to return to the happy, seemingly always smiling John from before the stroke. He’s walking now without any assistance. He extends his left hand to shake mine. He smiles. I think to myself, “I can’t imagine the emotional toll this has taken on you.” “God is good!” he tells me. “Yes he is.”
Friends, please get your blood pressure checked. If you feel like some of those risk factors I listed above hits home with you, take the steps to make a change. Stroke doesn’t just mean death. It can also mean that you're physically or mentally impaired, or BOTH for the rest of your life. If you have a family member that’s suffered a stroke, it’s time to start asking some questions and looking for symptoms of depression, which can also be confused with apathy. It’s not the same and could lead to recurrent strokes and even death.
Thanks for taking the time to read this post! I hope you found it valuable. If so, I ask you to share it with someone else that may find it valuable too.
1.Matsuzaki, S., Hashimoto, M., Yuki, S., Koyama, A., Hirata, Y., & Ikeda, M. (2015). The relationship between post-stroke depression and physical recovery. Journal of affective disorders, 176, 56-60.
2.Cojocaru, G. R., Popa-Wagner, A., Stanciulescu, E. C., Babadan, L., & Buga, A. M. (2013). Post-stroke depression and the aging brain. Journal of molecular psychiatry, 1(1), 14.
3.Alajbegovic, A., Djelilovic-Vranic, J., Alajbegovic, S., Nakicevic, A., Todorovic, L., & Tiric-Campara, M. (2014). Post stroke depression. Medical archives, 68(1), 47.
4.Park, G. Y., Im, S., Oh, C. H., Lee, S. J., & Pae, C. U. (2015). The association between the severity of poststroke depression and clinical outcomes after first-onset stroke in Korean patients. General hospital psychiatry, 37(3), 245-250.
5.Hankey, G. J. (2017). Stroke. The Lancet (British edition) (0140-6736), 389 (10069), 641-654.
6.McCance, K. L., & Huether, S. E. (2015). Pathophysiology: The biologic basis for disease in adults and children. Elsevier Health Sciences.
7.Bogiatzi, C., Hackam, D. G., McLeod, A. I., & Spence, J. D. (2014). Secular trends in ischemic stroke subtypes and stroke risk factors. Stroke, 45(11), 3208-3213.
8.Shi, Y., Xiang, Y., Yang, Y., Zhang, N., Wang, S., Ungvari, G. S., ... & Wang, Y. (2015). Depression after minor stroke: Prevalence and predictors. Journal of psychosomatic research, 79(2), 143-147.
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