Many people with conditions like multiple sclerosis, epilepsy, traumatic brain injury, Alzheimer’s disease, or stroke experience depression. A Danish study in 2016 of stroke survivors found that more than half developed depression within the first three months, and 25 percent were diagnosed with depression two years later. Similar statistics have been reported for other neurologic conditions.

“Cognitive impairment and other neurologic conditions significantly increase the risk for depression, whether you have had depression previously or not,” says Scott Hirsch, MD, a neuropsychiatrist with Contemporary Care of America in Greenwich, CT.

The connection between depression and neurologic disease isn’t entirely clear, and theories vary, depending on the disorder. “Sometimes there can be a purely biological cause, such as biochemical changes in the brain caused by a stroke,” says Dr. Hirsch. After a stroke, the amygdala, the part of the brain involved in regulating emotions, is often damaged, and levels of brain-derived neurotrophic factor (a protein that affects mood) and the stress hormone cortisol are reduced—all of which can trigger depression. And in Parkinson’s, for example, it may be caused by a drop in dopamine.

People who have co-occurring conditions such as cancer and diabetes may also be more prone to depression. “In general, when people are chronically ill with any condition, not just a neurologic disorder, they are more likely to experience depression,” Dr. Hirsch says.

And psychosocial factors, including social isolation, loneliness, and bereavement, can contribute to depression, says Nada El Husseini, MD, FAAN, associate professor of neurology at Duke University Medical Center in Raleigh, NC.

Whatever the cause, it’s important to treat depression. Otherwise, it can lead to isolation, more severe depression, cognitive decline, and even suicide. Here’s what you can do if you think you or a loved one might have depression.

Know the signs. “Some of the most common early signs include sleep disturbances, decreased energy, changes in appetite or activity levels, and decreased concentration,” says Dr. El Husseini. “It’s easy to miss these signs or to assume they are symptoms of the neurologic condition itself rather than of depression.” Another warning sign is loss of interest or pleasure in doing things that you once enjoyed.

Reach out for help. “If a depressed mood or sadness lasts longer than two weeks and you still aren’t enjoying the things you used to, talk to your primary care provider or your neurologist,” Dr. Hirsch says.

Seek treatment. Depression can be addressed through lifestyle approaches, medication, and therapy, says Dr. El Husseini. “To begin, I usually focus on making sure the person is getting enough physical activity and restful sleep. I also make sure they’re eating a healthy diet and avoiding excessive alcohol use. If they smoke, I encourage them to quit.” Talk therapy can help people focus on problem-solving, managing “ruminative thoughts” (excessive focus on problems, negative life events, or symptoms of depression), and coping with grief. Antidepressants also can be helpful. Your doctors can recommend the most appropriate antidepressant medication that will not have negative interactions with other drugs you are taking. “We will usually start with small doses in order to monitor the side effects,” Dr. El Husseini says. “In clinical trials, we have seen a 50 to 65 percent response rate to antidepressants in people with neurologic conditions.”


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