Post stroke depression often neglected

Antidepressants may not work as expected

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.

A review of research on depression treatment after strokes conducted by the German Institute for Quality and Efficiency in Health Care (IQWiG) has found that antidepressants may not have the expected effects in stroke patients. Because of their adverse effects and interactions with other drugs, antidepressants should only be used with caution.

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 often not enough awareness about the problem.

"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, says Prof Sawicki. 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.

Studies have found that antidepressants may 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 also urge caution in their use.

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."

To assist patients and those people close to them the Institute has published information about post stroke depression at its Informed Health Online website.

The website also provides information on occupational therapy, physiotherapy and how people can support their friends and family members who are depressed.