Middle-aged people and seniors with depression have a high risk of stroke even after an episode of depression passes.
These results came from a study of data from more than 16,000 participants age 50 and older. Every two years between 1998 and 2010, participants reported on their mental state and health habits. Both men and women who suffer from depression have a higher risk of stroke, other research shows, though the link may be stronger for men. But it wasn’t clear how long the effect lasted. In this study, some people reported depression at one interview, but not two years later. Researchers were surprised to find that even when that happened, the stroke risk in this group was 66 percent higher than if they’d never been depressed.
Chronic inflammation, sometimes after an infection, may play a role in both depression and stroke. Once people are depressed, they may smoke more, forget their medications, and skip exercise. Depression — or a shared cause — leads to other body changes. For example, depression is linked to high blood pressure and “type 2” diabetes, which increases stroke risk, too.
If you’re debating taking an SSRI or continuing with your prescription, and are concerned about stroke for other reasons, talk over the issue with your doctors. The case for anti-depressants is mixed; they work better for major, rather than mild depression. And there’s been some concern that SSRI anti-depressants could trigger strokes, especially after a medication change. However, a nine-year study of more than a thousand people with major depression at the beginning of the research found no link. Half of the people who had strokes were unmedicated for depression at the time and nearly all of the rest had not changed medications. A history of being difficult to treat with anti-depressants didn’t predict more stoke, but more severe cases of depression did.
Depression tends to make you assume the worst outcome. Remember that a stroke isn’t inevitable and your concern can give you a push and extra discipline to take especially good care of yourself, which will also boost your mood.
The major risk factors for stroke are hypertension, diabetes, alcoholism, and old age. Research shows how you can reduce your stroke risk: Do everything your doctors recommend to reduce high blood pressure and high cholesterol. Quit or cut back on a smoking habit, drink less alcohol, don’t let yourself become obese or lose weight, and increase physical activity. You may also want to cut back on red meat.
You may feel reluctant to report depression to your primary care doctor, especially if you’re feeling cheerier and back to your usual activities. However, even if you’re being treated for depression by a psychiatrist or psychotherapist, your primary care doctor needs to know your history of emotional health in order to judge how to treat other health problems.
After a stroke, the risk of depression goes up as well, especially among women and younger patients. That depression could contribute to unhealthy habits, another stroke — or suicide. It’s essential to get help and not try to tough it out without a confidante. Don’t underestimate the power of exercise to boost mood: Studies with rats show that Prozac works much like exercise, although exercise actually was slightly better.
June 23, 2015
Christopher Nystuen, MD, MBA