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Down in the dumps? It could be a sign of an impending stroke, study warns

If you’ve been down in the dumps lately, it could be a sign you’re at risk of a stroke.

Researchers have found people who suffer one are more likely to feel lonely, sad and fed up in the years before it happens.

Depression symptoms are common in patients after a stroke, but experts are calling for more research to see if they also provide an early warning sign.

The reasons for the link are unclear but the effects of stress-induced inflammation on blood vessels may be involved. 

Lead author Maria Blöchl, of the University of Münster in Germany, said: ‘Depression is not only a post-stroke issue, but also a pre-stroke phenomenon.

‘Even slight increases in depressive symptoms, especially mood and fatigue-related symptoms, may be a signal a stroke that is about to occur.’

The study looked at 10,000 older adults, who did not have a history of stroke, for more than 10 years.

Participants were surveyed every two years about their mood and assigned a score based on how many depression-like symptoms they had.

Researchers found stroke patients were more likely to have a higher score two years before the condition.

Researchers have found people who suffer a stroke are more likely to feel lonely, sad and fed up in the years before it happens (file image)

THE CAUSES OF STROKE 

There are two major kinds of stroke: 

1. ISCHEMIC STROKE 

An ischemic stroke – which accounts for 80 per cent of strokes – occurs when there is a blockage in a blood vessel that prevents blood from reaching part of the brain.

2. HEMORRHAGIC STROKE 

The more rare, a hemorrhagic stroke, occurs when a blood vessel bursts, flooding part of the brain with too much blood while depriving other areas of adequate blood supply.

It can be the result of an AVM, or arteriovenous malformation (an abnormal cluster of blood vessels), in the brain.

Thirty percent of subarachnoid hemorrhage sufferers die before reaching the hospital. A further 25 per cent die within 24 hours. And 40 per cent of survivors die within a week.

RISK FACTORS

Age, high blood pressure, smoking, obesity, sedentary lifestyle, diabetes, atrial fibrillation, family history, and history of a previous stroke or TIA (a mini stroke) are all risk factors for having a stroke.

SYMPTOMS OF A STROKE

  • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
  • Sudden confusion, trouble speaking or understanding
  • Sudden trouble seeing or blurred vision in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden severe headache with no known cause

OUTCOMES 

Of the roughly three out of four people who survive a stroke, many will have life-long disabilities.

This includes difficulty walking, communicating, eating, and completing everyday tasks or chores. 

TREATMENT 

Both are potentially fatal, and patients require surgery or a drug called tPA (tissue plasminogen activator) within three hours to save them. 

Dr Blöchl added: ‘Depression is among the most pressing problems in people who have had a stroke and it is so common it is referred to as 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.’

Researchers looked at 10,797 adults with an average age of 65, who were followed for up to 12 years. During that time, 425 had a stroke.

They were matched with 4,249 people who did not have one but were similar in their age, gender, ethnicity, and other health conditions. 

Participants took a survey every two years asking whether they experienced symptoms of depression in the past week.

These included feeling depressed, lonely, sad, or that everything was an effort, as well as if they had experienced restless sleep.

The more symptoms participants had, the higher their score. 

Researchers found no difference in scores six years before a stroke, with both groups scoring around 1.6 points.

But those who did go on to suffer one scored, on average, 0.33 points higher than those who didn’t two years in advance.

Dr Blöchl added: ‘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.’

The researchers also looked at whether stroke sufferers were more likely to be diagnosed with depression before suffering the complication.

They found patients were 5 per cent more likely to have clinical depression than their peers in the years before a stroke.

‘This suggests that increasing symptoms of depression before stroke are mostly subtle changes and may not always be clinically detectable,’ said Dr Blöchl.

Strokes are caused when the brain loses its blood supply, often because of a clot in a blood vessel, known as an ischemic stroke.

Less common hemorrhagic strokes occur when a blood vessel bursts, flooding the brain with too much blood while depriving other areas of adequate supply.

Around a third of stroke patients go on to develop depression at some point, which is often caused by biochemical changes in the brain.

But in some cases it is a psychological reaction to the physical trauma of a stroke.

A 2020 study by the University of Cambridge on half a million Britons found people who experience depression are more likely to go on to develop heart disease or suffer a stroke later in life.

The reasons are still not clear but depression could be a sign of poorer health more broadly. 

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