Presented at Psychiatry Sharing Moment, Department of Medical Rehabilitation, Hospital Kuala Lumpur. 12-13 October 2016.

1. UNDERSTANDING
LOW MOOD & DEPRESSION
AFTER STROKE
Dr. Umi Adzlin bt Hj. Silim I Consultation-Liaison Psychiatrist I HKL I
13th October 2016

4. • Many stroke survivors experience feelings of anger, frustration,
anxiety, sadness, fear, and hopelessness in varying degrees.
• These emotions are common with post-stroke depression, which
affects more than a third of stroke survivors

5. ARE THERE ‘understandable’ depression &
ANXIETY
or
DEPRESSIVE & ANXIETY
illnesses?

6. FEELING DEPRESSED/SAD AS A NORMAL
PSYCHOLOGICAL REACTION
VS
DEPRESSIVE DISORDERS

7. FEELING ANXIOUS/WORRIED/FEARUL
AS A NORMAL PSYCHOLOGICAL REACTIONS
VS
ANXIETY DISORDERS

9. • Depression is more than just feeling sad.
• People with depression find it hard to function every day and may be
reluctant to participate in activities they once enjoyed.
• It has serious effects on both physical and mental health.
• Functional recovery
• Cognitive function
• Survival

10. • An anxiety disorder is more than just feeling stressed, for some
people these anxious feelings are overwhelming and cannot be
brought under control easily.
• It’s a serious condition that makes it hard for the person to cope from
day to day.

14. Two questions:
• 1. Prior to your stroke, have you ever felt sad or depressed? (Yes/No)
• 2. Since your stroke, have you been feeling sad or depressed?
• A further clinical assessment should follow if these two are affirmative, in line with
national guidance.
• Also be mindful of the range of psychological problems we may face: I might not be
depressed but I may be very stressed, or anxious, or angry.

15. • Depression Intensity Scale Circles (DISCS)
If the patient points
to this circle (a
score of 2), or any
higher- this would
indicate low mood.

16. • Depression can set in weeks, months, or even years after your stroke
and can stop your progress of recovery and rehabilitation, impacting
your quality of life.

17. • A combination of factors can lead to post-stroke depression. The
sudden nature of stroke can have a life-changing impact. Also, the
damage to your brain after a stroke, genetics, and social factors can
also contribute to depression.

18. • it can worsen a number of other common post-stroke conditions such
as malnutrition, incontinence, pain, fatigue, and sleep issues.
Depressive emotions can increase when you are frustrated about not
making progress in recovery. There are a variety of treatmen

19. • Communicate. Talk about your feelings, post-stroke issues, and concerns with your caregivers, family, and friends. Relationships may change after a
stroke and it may take time to adjust to new roles.
• Improve nutrition. Foods rich in omega-3 fatty acids, folic acid, vitamin B, and complex carbohydrates can help improve mood and fight depression.
• Omega-3 fatty acids (fish, flaxseed, walnuts) promote brain health.
• Complex carbohydrates (brown rice, oatmeal and whole wheat) boost neurotransmitter chemicals in the brain that affect mood.
• Dark chocolate helps fight fatigue and reduce stress.
• A deficiency in folic acid (found in beans, oranges, and broccoli) is linked to depression; folic acid boosts neurotransmitters and promotes cognition.
• Vitamin B12 (eggs, milk, liver) increases energy and alertness.
• Attend a stroke support group. National Stroke Association’s Stroke Support Group Registrylists hundreds of support groups throughout the U.S.
• Set realistic goals and prioritize. Break up larger tasks or projects into smaller ones.
• Practice stress and anxiety management techniques. Deep breathing, squeezing a stress ball, guided imagery, aromatherapy, meditation, and taking a
walk or journaling can be very helpful.
• Be patient with yourself and loved ones. Stroke can be traumatic and recovery takes time.
• Stay as active as possible. Adaptive equipment and aids such as canes, braces and walkers can help stroke survivors improve physical fitness. Walking,
yoga, and swimming, are low-impact and promote recovery.
• Get out into the community. Volunteering for a cause you believe in, returning to work, taking cooking classes, or joining a club can be exciting.
• Minimize or eliminate alcohol consumption and smoking.