Can antidepressants be used to treat depression after a brain injury or stroke?
Antidepressants help rebalance natural chemicals in the brain called neurotransmitters to a more natural state. Doing so can help a person's mood get back to normal. What we usually do in people with a brain injury or an injury to the brain like a stroke is that we try to start at relatively lower doses and go up at a slightly slower pace than what we would do with people without a brain injury. And when you do that, what we call “start low, go slow,” people generally do tend to tolerate the medications pretty well.
There are a number of patients who would prefer not to take an antidepressant, partly because they’re already on a lot of medications. Sometimes people who have had a brain injury are on pain medications, even seizure medications. So it’s understandable that some people might not want to take another medication and would prefer counseling, for example.
And so it’s very important that patients — and their families — really be a close partner in the decision-making process of what are the best options and the best approaches for them in dealing with their depression.
Unfortunately, there is a stigma associated with taking an antidepressant even though in the general population the rates of antidepressant use are increasing over time. A lot of people have negative images of antidepressants from media reports that are often inaccurate. People can get some side effects from antidepressants, like they can with any medication, but many of those side effects can and usually do go away after one to two weeks as the body and the brain kind of gets used to it.
Antidepressants are not addictive, and they do often take several weeks to get their full effect. So, it’s very important that people take the medication every day, and once they do start to feel better, often in a few weeks, they should continue to take the medication even if they are feeling better.
Jesse Fann, M.D., M.P.H., is a consultation-liaison psychiatrist in the Department of Psychiatry and Behavioral Sciences at the University of Washington and an adjunct professor in the UW departments of Rehabilitation Medicine and Epidemiology. His clinical interests include consultation-liaison psychiatry, psychiatric oncology and neuropsychiatry. His research interests include psychiatric epidemiology, health services research, psychiatric oncology and neuropsychiatry.