Post-stroke depression is a depressive disorder that occurs in stroke patients, or a mood disorder characterized by depression or accompanied by major depressive-like manifestations as a result of stroke.
Patients with post-stroke depression are depressed, unhappy, disinterested in daily activities, people and things around them, hopeless, pessimistic and desperate about the future, anxious, and unconcerned about the recovery of their condition.
The incidence of post-stroke depression varies widely among reports, ranging from 10-64%. One third of these patients occur in the acute phase of stroke, within one month, and about half of them develop it about six months after the stroke. Depression that occurs a few days after a stroke usually recovers spontaneously; in contrast, few patients who start 7 weeks or later after a stroke recover spontaneously.
Post-stroke depression reduces the patient’s efforts to recover actively, and even delays the time of neurological recovery, which seriously affects the recovery of neurological function and life safety of post-stroke patients (the mortality rate of depression after stroke is high).
Who is prone to depression after stroke?
Post-stroke depression can occur for pathological and psychogenic reasons. Pathogenic causes refer to depression caused by stroke, which damages specific parts of the brain and leads to the destruction of 5-hydroxytryptaminergic and noradrenergic neurons, causing a decrease in both neurological functions. Psychogenic causes refer to the patient’s specific psychological type of stress response to the stroke. Most post-stroke depression is of a compound type.
The risk of post-stroke depression increases when the following conditions are present.
1. personal factors.
Introverted or overly aggressive personality who cannot accept the reality of loss of function after a stroke, resulting in severe depression. According to foreign studies, patients with personality changes such as “high degree of neuroticism, reduced extraversion and reduced sense of responsibility” seriously affect the psychological adjustment after stroke. In addition, pre-stroke self-awareness, herding, frankness, and thoroughness of thinking can be used as predictors of post-stroke depression, such as self-centeredness, demanding full care from family members, not getting along, not getting along with patients in the same ward, not being able to talk openly with others, and being paranoid in dealing with problems.
Family disharmony, lack of care from relatives after the illness, patients feel isolated and abandoned by their families. Especially when family members show that they are tired of caring for the patient and complain about the impact of caring for the patient on their work life, the patient will become more pessimistic and may even develop behaviors such as refusing treatment.
Economic tension, lack of sufficient treatment costs, and loss of confidence in recovery from the disease.
The more educated patients, who pursue a high quality of life as well as a higher level of spiritual needs, the more likely they are to become depressed after a stroke.
2. Social factors.
In particular, patients who held important positions before the disease, or were busy at work, or were widely recognized at work, the more socially influential they were before the disease, the more worried they were about not being able to return to society and resume work, generating thoughts of being a waste of time, and severely reducing their self-evaluation, which manifested as depression.
3. lesion site: the neurotransmitter theory of depression suggests that depressed patients have low levels of monoamine neurotransmitters, and the main functional area of monoamine neurotransmitters is the nucleus of the middle suture located in the low brainstem, whose nerve fibers project to the striatum, thalamus, temporal lobe and frontal lobe of the cerebral cortex; according to another study, depressed patients have decreased cerebral blood perfusion in certain specific areas; decreased cerebral blood perfusion is more common in the left side, and , cerebral perfusion is related to the severity of depression, which may be used as one of the biological indicators for the diagnosis of major depression, suggesting that: stroke occurs in the frontal lobe, temporal lobe, parietal lobe, basal ganglia, and low brainstem of the left side of the brain, and the possibility of post-stroke depression is higher.
Home care.
1. Psychological care
For patients suffering from post-stroke depression, the patient’s psychotherapy and psychological care should not be neglected; supportive psychotherapy should run through the whole process of stroke rehabilitation, and positive psychotherapy can evoke the patient’s strong will and desire for recovery, improve his or her negative perception, and lay the foundation for the recovery of neurological deficits.
Patients who are depressed and self-blaming should be treated with kindness and patient explanation to reduce psychological pressure. Family members should try to use positive suggestive language when asking questions, such as “Are you in a good mood today?” or “Do you feel strong again today?” Try to avoid negative suggestive questions, such as “Are you in a bad mood today?” . If the patient is overly worried and anxious about the disease, play down the word “disease” to reduce anxiety and depression. Encourage more and interrupt less, give vent to their feelings, and express sympathy and understanding at the right time.
For patients who repeatedly ask to commit suicide, in addition to a kind attitude, language should also be clear, dare to discuss suicide with the patient, take the initiative to involve the symptoms, and do not be afraid to stimulate the patient. Let the patient know that the family understands the patient’s current mood very well and that it is selfish to tell the patient that taking suicidal behavior to end his or her life will leave more pain to the family. At the same time, it is important to strengthen the care and check the safety of the surrounding environment to prevent accidents.
Family members who are accompanying the patient in the hospital. When reflecting the condition to the examining doctor, the same attention should be paid to avoid impatience, and in the presence of the patient, try to reflect more aspects of improvement, affirm the progress of the condition, and give the patient positive psychological support.
2. Functional rehabilitation
Effective rehabilitation is the best gift for post-stroke depressed patients, therefore, family members should actively cooperate with doctors. There is nothing more painful for a stroke patient than limb paralysis and aphasia. If these two aspects are well recovered, the patient will be able to resume self-care and work soon.
For limb paralysis, the first step is to maintain the functional position of the affected limb and perform passive limb activities every day, especially passive activities of small joints.
For aphasia, patiently carry out language training, even word by word, from single word practice, gradually carry out the practice of two words, three words, small phrases, encourage the patient to use language to express his requirements, encourage the patient to speak more, and praise the patient in time when he makes an attempt and succeeds.
3. Dietary management
In patients with post-stroke depression, dietary modification should take care of both stroke and depression.
According to the patient’s eating function, give a liquid, semi-liquid or normal diet.
The diet should be low in salt and fat, avoiding spicy and stimulating foods, with the intake of easily digestible high-quality protein as the mainstay. In patients with combined elevated blood sugar, the intake of sugar and starch should be reduced, and fresh vegetables and fruits are essential.
Two medicinal meals
Acacia peach kernel drink
Ingredients: 10 grams of acacia bark, 10 grams of peach kernel, 30 grams of cassia seeds, 250 grams of fresh parsley, white honey.
Practice: first wash the parsley, using a juicer to squeeze 30 ml of fresh juice spare. Put the peach kernel and cassia seeds into a casserole with water and decoct the juice, then add fresh parsley juice and white honey, mix well and drink.
Effects: Soothing the liver and clearing heat, invigorating the blood and relaxing the bowels.
Indications: It is suitable for patients with post-stroke depression with constipation.
Chai Yu Chicken Soup
Ingredients: 90g chicken, 10g Chai Hu, 10g Yu Jin, 10g Tian Qi, 10g Huang Qi.
Method: Crush the ginseng, add chicken and 3 slices of ginger to oil, put all ingredients into a wok, add water, cook for two hours with moderate heat, season to taste, and drink with rice.
Effects: Relieve liver and depression, benefit qi and activate blood
Indications: Suitable for people with hemiplegia, unfavorable language, memory loss, sullenness, little speech and little movement.