About 8% of stroke survivors have thought about suicide or thought they'd be better off dead, a survey suggests. Researchers said the percentage of those pondering suicide after stroke was higher than for people who had heart attacks, cancer or other health problems. The study was based on a large national health survey taken during the years 2005 through 2010. It included a total of 17,000 people. In all, 678 reported having a stroke at some time in the past. People were asked: "Over the last two weeks, how often have you been bothered by thoughts that you would be better off dead, or of hurting yourself?" About 6% of heart attack survivors, 5% of people with diabetes and 4% of people with cancer reported such thoughts. A stroke damages the brain. That damage might affect mood and lead to higher rates of depression than with the other conditions, an expert not linked to the study told the Associated Press (AP). Survey results were presented at a meeting of the American Stroke Association. AP wrote about the study February 7.

By Mary Pickett, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

"Over the last two weeks, have you been bothered by thoughts that you would be better off dead, or had thoughts of hurting yourself?"

Among people who have had a stroke, 1 out of 12 people who were asked this question said "yes." That was twice the rate of "yes" answers for people diagnosed with cancer, and more than for people with either diabetes or heart disease.

This information came from National Health and Nutrition Surveys that were completed between 2005 and 2010. Out of more than 17,000 adults surveyed, 678 reported a history of stroke.

Stroke is the fourth leading cause of death in the United States. Most people who survive a stroke consider themselves lucky. Most stroke survivors remain independent, or regain independence.

But one-quarter live in a nursing home six months after stroke. About half have lasting weakness on one side. About one-quarter are dependent in one or more basic activities, such as bathing, dressing or eating. Nearly one-third can't walk without help. Years after a stroke, survivors may still feel like a burden to others. They may even wish that they had not survived.

Clearly, stroke patients need more help from us -- from their doctors and from their community. We can do more to help stroke patients gain back independence and adjust to lasting disabilities. If you are a stroke patient, there may be more you can do for yourself, too.

What Changes Can I Make Now?

If you ever have a stroke, these treatments might help:

• Immediate care -- The most effective treatment for stroke is thrombolysis. For strokes caused by a blood clot, this treatment uses a drug that dissolves the clot. With this treatment, you are less likely to have a lasting disability. But it is effective only if given within three hours after symptoms start.



• Physical and occupational therapy -- The first six months are the most important time for recovery of function after a stroke. However, physical therapy can help some people improve even nine or more months after a stroke. An occupational therapist may be able to provide creative tools to help you do tasks that have become difficult.



• Constraint-induced movement therapy -- This is a new form of physical therapy. The technique usually involves having your "good" arm held by a splint or restraint for six hours or so each day. This occurs daily for two weeks. The technique forces you to exercise your weak hand and arm to do minor tasks. It can help you to gain maximum use of the arm that has lost function.



• Splints -- if you have foot drop, it is helpful to prop your ankle into a 90-degree bend, so that your foot does not drag when you walk. Frequent use of an ankle-foot orthotic, a kind of foot support, can prevent your foot from stiffening permanently into a position that would interfere with walking.



• Botox -- Injection with botulinum toxin (Botox) may help if you have difficulty moving your hand, arm or leg. The toxin is used to weaken those muscles that are in spasm. Sometimes this can permit better motion in a joint. This treatment is recommended only if your stroke symptoms have lasted for longer than six months.



• Antidepressant medicine -- Treatment with the antidepressant escitalopram (Lexapro) has been shown to benefit recovery of thinking, learning, memory and verbal skills. Fluoxetine (Prozac) was shown to improve limb strength and function for people who had weakness and paralysis. Both of these were given in the first three months after a stroke. Prozac also improved the odds of being able to live outside of a nursing home after a stroke. These drugs are very similar antidepressants, known as SSRIs. Researchers think they may help after a stroke by stimulating brain chemistry. This may allow more chemical and electrical connections to form between cells.

What Can I Expect Looking to the Future?

New devices are helping recovery after stroke.

One technology used in an increasing number of rehabilitation centers is body-weight-supported treadmill training. A harness around the chest and pelvis supports part of the weight during treadmill training. This allows improvement in walking coordination and leg strength without the need to support full body weight. This technology has produced great results for patients who are learning how to walk again.

Experimental technologies after stroke include straps and wraps that have embedded electrodes. Electrode stimulation can improve results from repetitive exercises that aim to strengthen a weak arm. Electrode garments can be used to prevent foot drop by triggering the ankle to flex during the leg "swing" phase of walking. Electrodes have also been able to improve swallowing problems after stroke. More uses are sure to be created.