Depression, anxiety, apathy more likely for stroke survivors

Stroke survivors have a dramatically increased likelihood of developing depression, anxiety, fatigue and apathy, compared to normal rates, a global review has found.

Lead author Associate Professor Maree Hackett, of The George Institute for Global Health and The University of Sydney and colleagues, found that common mental health consequences of stroke occur in at least 30 per cent of the patient population.

“There appears to be an increased risk of mental health concerns in stroke survivors when compared to the general population. While the linking factors between stroke and these mental health concerns are unknown, we are lacking simple prevention and treatment strategies for most concerns.”

“This also raises questions about whether there are shared underlying biological mechanisms resulting from injury to the brain that are responsible, or perhaps this is simply a natural reaction to having recently experienced a life-threatening event.”

Every year approximately 16 million people worldwide suffer from their first stroke. From this number, 5.7 million die while 5 million remain some way disabled.

The invited paper, published in The Lancet Neurology, reviewed existing studies looking at mental health problems such as depression, anxiety, fatigue, apathy, mania and personality change in stroke survivors, and identified potential research avenues.

Associate Professor Hackett says there is an unmet need for mental health treatment for these people, particularly as post-stroke problems such as aphasia (loss of speech) and cognitive impairment can make distinguishing symptoms of mental ill health difficult.

The review authors, however, found that the most effective treatment for most of these mental health concerns remain undetermined. A collection of trials on stroke survivors revealed that antidepressant medication for those with depression was effective for those with severe clinical depression, however there was an associated increase in side effects.

Associate Professor Hackett says: “We need careful screening for these neuropsychiatric symptoms, as the overlapping symptoms of post-stroke impairment and mental health disorders make current diagnosis difficult.”

Richard Lindley, chair of the National Stroke Foundation Clinical Council, said: “This recent research confirms that depression and stress should be considered as risk factors for stroke, perhaps as important a risk as having diabetes. On the positive side, the research also emphasises the importance of physical activity and a healthy diet in preventing stroke.”

“Future research into prevention and treatment is also necessary in order to help stroke survivors maintain a healthy frame of mind during their recovery.”