Stroke is one of the leading causes of death and disability in Canada. But what is not widely known is that patients often develop depression after a stroke, even if they have fully recovered from it.
“Stroke is a perfect example of an acute serious insult to the brain and subsequent psychiatric problems,” says Dr. Nathan Herrmann, head of the division of geriatric psychiatry and a scientist in the Brain Sciences Research Program at Sunnybrook Health Sciences Centre. “For me, it is an ideal area to do research. We are helping people in their day-to-day lives.”
Dr. Herrmann and his team of scientists are doing cutting-edge research aimed at recognizing and preventing depression after a stroke.
Studies show depression occurs in somewhere between 11 per cent and 63 per cent of post-stroke patients. Those who do develop depression are statistically less likely to do well in rehabilitation, to have reduced quality of life and, in fact, to die earlier than those without depression. Their additional illness is very hard on their caregivers and loved ones. Yet, says Dr. Herrmann, “a lot of post-stroke depression is not detected and treated properly. Clearly this is an important and unrecognized issue.”
Dr. Herrmann has found some vital clues into which patients will develop depression or cognitive impairment after a stroke. For instance, chemical markers in the blood responsible for inflammation may also be important in predicting post-stroke cognitive impairment. Neuroimaging technology has also been used to discover that the location in the brain where the stroke occurred may be predictive of depression.
He is developing new, simple tools for doctors to screen for depression post-stroke. “It’s really crucial for clinicians to recognize stroke patients frequently have problems with cognition and mood. If we pick it up, we can begin to address and treat patients and improve their outcomes,” he says.
Another exciting avenue of research is the use of medication to improve brain health after a stroke. In a new study that is enrolling patients now, Dr. Herrmann’s team will observe, using brain MRIs, the effect of prescribing lithium carbonate to people who have had a stroke. “This is incredibly interesting. We think giving post-stroke patients lithium may improve symptoms of depression, increase brain size, improve rehabilitation, and prevent cognitive impairment that occurs following stroke.”