Aphasia and Depression after a Stroke
The Unspoken Psychosocial Side of Stroke-Induced Aphasia
Jun 19, 2009
A stroke, or cerebrovascular accident (CVA), can affect a person’s speech as well as a host of other body functions. Stroke survivors may suffer from depression, but the depression may go unrecognized due to aphasia.
Aphasia literally means no speech. Someone suffering from a stroke may experience one or more of several different types of aphasia, such as being unable to verbalize certain sounds, having difficulties processing language, or being unable to perceive what is said. These language difficulties can range from mild to severe.
According to the 2003 article “The relevance of emotional and psychosocial factors in aphasia to rehabilitation” by Chris Code and Manfred Herrmann, aphasia can have an effect on emotional well-being, which in turn can impact treatment outcomes. This article examines several issues related to depression and stroke as discussed below.
Is the Stroke Survivor Depressed?
One of the best tools in determining whether or not someone is depressed is to ask him about his mood. Asking someone with a brain injury resulting in aphasia presents problems because the person may not be able to comprehend or express words or ideas, although several tools have been developed to try to improve the accuracy of results.
Several types of depression related to stroke have been identified:
Primary Depression
- Usually occurs during the acute stage at 0-3 months after a stroke
- Tends to be related to the physical brain injury
- People with an injury to the frontal lobe and basal ganglia are most at risk
- People who were high risk for depression before the stroke may be more likely to exhibit depressive symptoms
Reactive or Secondary Depression
- Typically occurs within the first six months after the stroke
- People who initially deny stroke ramifications tend to be particularly at risk
- Symptoms of depression may surface as disabilities linger and positive rehabilitation results do not occur as rapidly as the person originally hoped
- The reality of disability and prolonged rehabilitation needs begins to set in
Tertiary Depression
- Associated with the move from in-patient to out-patient care after a stroke
- Emerges as previous social roles are affected by current disabilities
- May make previously existing depression worse
Options for Those Suffering from Depression after a Stroke
- The primary decision-maker should shift responsibility from a caregiver to the stroke survivor as cognitive function improves, which encourages autonomy and feelings of self-worth
- Individual, group and/or family counseling
- Psychotherapy
- Medications, although various experts disagree on when and what medications are appropriate
- Return to work and/or other meaningful activities
- Community-based programs, particularly those involving volunteers trained to help others to become better conversation partners
- Self-help groups
Treating Depression after a Stroke May Improve Physical Rehabilitation Outcomes
A 1988 study by Starkstein and Robinson found that people suffering from aphasia and depression exhibited lower recovery rates and significantly more cognitive impairment when compared to those who were not depressed. Addressing emotional and psychosocial needs after a stroke may improve mood and motivation and ultimately result in a quicker and more complete recovery.
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