Neurologic Conditions and how they Relate to Depression

When working with conditions that affect the brain it seems highly logical that a major condition like a Stroke, Epilepsy and/or Parkinson’s Disease could also trigger depression. How about vice versa, Could being susceptible to bouts of depression place you at a higher risk of a larger neurological condition?  Could some Neurologic medications be linked to depression?  If you have been diagnosed with a stroke, epilepsy or Parkinson’s disease, how do you check if you are also suffering from depression? What are some ways to deal with depression?

The Link: Neurologic Disorders and Depression

The rate of depression among stroke patients is about eight times higher than in the general population, according to a 2016 study in JAMA Psychiatry. Of the 135,000-plus patients in the study, 25 percent were diagnosed with depression within two years of their stroke. In that group, more than half developed depression within the first three months after their stroke. This correlation extends to other neurologic disorders, including epilepsy and Parkinson’s disease

Depression related to epilepsy, Parkinson’s, or stroke seems to have a biological basis. “The relationship between epilepsy and depression goes both ways: People with epilepsy have a higher risk of depression, but people with depression also have a two-fold higher risk of developing epilepsy compared to the general population,” says Dr. Kanner. “We think this is because the changes in neurotransmitters that occur during epilepsy are very similar to the changes we see in depression.” Both involve increases in glutamate, a neurotransmitter crucial for learning and memory, as well as decreases in the neurotransmitter GABA, which slows brain activity, he says. 

The link between depression and Parkinson’s disease appears to be low levels of the neurotransmitter dopamine, says Nikolaus McFarland, MD, PhD, FAAN, acting chief of the movement disorders division at the University of Florida in Gainesville. Dopamine is crucial not only for motor control but for mood, sleep, memory, learning, and concentration, he says.

 About 55 percent of people who’ve had a stroke will develop depression at some point,” says Nada El Husseini, MD, associate professor of neurology at Duke University Medical Center in Durham, NC. “A stroke often damages the amygdala, a part of the brain involved in regulating emotions. It also reduces levels of brain-derived neurotrophic factor (BDNF), a protein that affects mood, and raises levels of the stress hormone cortisol.” All of this combines to create a potentially persistent, disabling depression.

Depressive symptoms may begin before the advent of Parkinson’s motor symptoms. A review published in Neurology in 2015 found that people are three times more likely to be diagnosed with Parkinson’s within a year of being diagnosed with depression than those who aren’t depressed. “This is probably due to the decrease of dopamine within the brain as Parkinson’s disease begins,” says Dr. McFarland.

Medicinal Links

In addition, certain medications used to treat epilepsy can trigger depression. While patients shouldn’t shy away from phenobarbital if their doctor recommends it, he adds, they should alert their doctor if they feel any mood changes.

Diagnosing Depression

Despite how common depression is, it often goes undiagnosed. “Not all doctors do a careful assessment or feel comfortable treating related depression or anxiety disorders,” says Dr. Kanner.

Screenings are available, though. For example, the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), developed 15 years ago by Dr. Kanner, is a six-item questionnaire that asks patients how often they experience feelings such as guilt, frustration, and difficulty finding pleasure.

For Parkinson’s patients, the most widely used assessment is the Unified Parkinson Disease Rating Scale, says Dr. McFarland. But it devotes only a single question to depression, so Dr. McFarland also uses the Beck Depression Inventory. This 21-question survey asks patients to rate everything from mood and sleep quality to sex drive and energy levels.

While several different scales seem to be effective in detecting depression among stroke survivors, a 2017 scientific statement by the American Heart Association says the Patient Health Questionnaire-9 is among the most practical.

4 Tips to Dealing with Depression

If you experience symptoms of depression, the first step is to notify your neurologist. Then talk to him or her about these treatment options.

  1. Antidepressants. “Research shows that the best treatment is a combination of antidepressant medication and some form of talk therapy,” says Scott E. Hirsch, MD, clinical associate professor of neurology at NYU Langone Medical Center.
  2. Talk therapy. Many types of therapy can help, but CBT, where you work with a therapist to identify and reshape thoughts and behavior patterns that contribute to your depression, is one of the most effective, says Dr. Kanner.
  3. Mind-body practices. Activities like yoga and tai chi can help relieve depression and anxiety.
  4. Exercise. “We know physical activity increases levels of serotonin and dopamine, releases endorphins, and lowers stress, which can boost mood,” says Nikolaus McFarland, MD, PhD, FAAN, acting chief of the movement disorders division at the University of Florida in Gainesville. 

Most patients respond well to a combination of antidepressants and talk therapy, but sometimes depression can linger. Some patients may also be at increased risk of suicide so be aware of the signs. These include talking about death or suicide, exhibiting behavior that might lead to self-harm (for example, purchasing a gun), and talking about feeling hopeless or having no desire to live. If family members or friends notice any of these signs, they should seek help for the person immediately, by calling the National Suicide Prevention Lifeline anytime at 800-273-8255 or by taking them to a psychiatrist or a walk-in psychiatric clinic. (Read more about How to Reduce the Risk of Suicide in People with Neurologic Conditions.)

Information for this article was taken from BrainandLife.org

 

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