Posted by medlib on March 28, 2001, at 21:05:53
In reply to Antidepressants folllowing strokes, posted by Lisa Greene on March 28, 2001, at 10:57:47
Lisa--
I am very familiar with your mother's condition. Several years ago I suffered a severe hemorrhagic CVA (stroke) in my right parietal lobe; I also have a life-long history of depression. Recent studies have shown that antidepressants (ADs) can be very helpful post-stroke; they can not only lift mood but also help recover cognitive status. (Some things just don't come back, though; my memory for proper names was never swift, but, post-stroke, it's truly abysmal.)
ADs are best prescribed by a pharmacologically-oriented psychiatrist (pdoc), rather than a neurologist or internist. But, that pdoc will need assurance from her neurologist that your mother's post-stroke brain scan showed no remaining areas of vulnerability (a "clean" CAT or MRI). Past and curent medical history will be required, especially any recent blood tests, blood pressure status and current meds. (Some psych meds can raise BP, others can interfere with metabolism of other meds.) Believe me, assembling this info prior to a pdoc appointment can save all of you a world of time and aggravation.
What in your mother's past experience with ADs makes her hesitant to take them again? Newer drugs are more numerous, more specifically focused and cause far fewer continuing side effects. Also, pdocs now prescribe a broad range of other types of meds besides ADs to help relieve depression and/or anxiety. For example, your mother's lethargy might be helped by a psychostimulant or her anxiety relieved by a small dose of a drug like Klonopin at bedtime. It's possible that 1 med (perhaps Effexor) may be all that's necessary, but most of us here take a "cocktail" of several meds customized through lengthy trial and error. If this approach is in your mother's future, your support and patience will be very important to her persistance and med compliance. Babble can help, as can group therapy and any structured activity that gets your mother out of the house.
For me, between stroke and depression, depression has proved the more formidable foe. Stroke left me with left-sided paralysis for 2+ months; depression has paralyzed me far more completely for far longer. I commend you for your caring concern for your mother and believe that you are wise to seek pharmacological help. Caring about and for a depressed parent is *very* stressful; although neither of you is at fault, don't be surprised to discover feelings of anger or resentment in yourself and guilt or shame in your mother. (Depression is an unattractive disease, and it is far less socially acceptable than stroke.)
I would be happy to share experiences with your mother on Babble, if she's interested. My stroke was pre-Internet, but I wish it and Babble had been available then. It's particularly helpful when one can't, for whatever reason, leave the house; and Babblers have been invaluable during my depression treatment odyssey.
In case I haven't already bored you with much more than you wanted to know (and/or offended you with too much that you already knew), here's a URL for further reading.
http://www.vh.org/Patients/IHB/Psych/StrokeDepression/StrokeDepression.html
Good luck and take care of yourself, too---medlib
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> Am looking for information regarding the use of antidepressants for treating depression post-stroke. ........
poster:medlib
thread:57784
URL: http://www.dr-bob.org/babble/20010327/msgs/57858.html