While depression is a prevalent condition for those who have had a stroke, some people may exhibit symptoms of depression years before their stroke, says a new study published today in the medical journal Neurology.

Researchers discovered that in those who experienced a stroke, depressive symptoms appeared before the attack and got worse after it.

Depression is one of the most serious concerns among persons who have had a stroke and it is so widespread that it is referred to as a post-stroke depression.

“But our study found depressive symptoms not only markedly increase after stroke, it found people already had developed some depressive symptoms before the stroke even occurred,” says study author Maria Blöchl.

A total of 10,797 adults with an average age of 65 and no prior history of stroke were examined for the study. Follow-up with the participants lasted up to 12 years. There were 425 strokes over the time period.

They were put together with 4,249 people who had not had a stroke but were of the same age, gender, race or ethnicity and had similar health problems.

Every two years, participants completed a survey in which they were asked whether they had recently experienced any of the following depressive symptoms: feeling down, lonely, unhappy, like everything was a struggle, or having trouble sleeping.

More symptoms, higher score.

Researchers discovered that six years prior to the onset of a stroke, persons who eventually experienced a stroke and those who did not have similar scores, about 1.6 points.

However, scores of those who had a stroke started rising, on average by 0.33 points, roughly two years before the stroke.

After the stroke, depression symptoms in this group rose by an additional 0.23 points, totaling around 2.1 points, and they remained at that level for 10 years.

In contrast, the ratings of those who did not experience a stroke were largely constant during the course of the investigation.

When analyzing whether individuals may be classified as clinically depressed if they scored three or more points on the scale, researchers discovered a slightly different pattern of results.

At the pre-stroke examination, 29 percent of those who were likely to experience a stroke satisfied the criteria for probable depression, compared to 24 percent of those who did not experience a stroke.

However, at the time of the stroke, 34 percent of those who had a stroke satisfied the criteria for probable depression, compared to 24 percent of those who did not have a stroke. Six years after the stroke, those figures remained almost unchanged.

“This suggests that increasing symptoms of depression before stroke are mostly subtle changes and may not always be clinically detectable,” adds the author, “But even slight increases in depressive symptoms, especially mood and fatigue-related symptoms, may be a signal a stroke that is about to occur.”

“Depression is not only a post-stroke issue, but also a pre-stroke phenomenon,” according to Blöchl. “Whether these pre-stroke changes can be used to predict who will have a stroke is unclear. Exactly why depressive symptoms occur pre-stroke needs to be investigated in future research. Also, the study underscores why doctors need to monitor for symptoms of depression long term in people who have had strokes.”

A weakness of the study was that there were insufficient data on depression therapies. Therefore, it’s probable that some patients who received antidepressants saw an improvement in their post-stroke depression symptoms.

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