We ask an expert how he would manage this case of an elderly woman who had a stroke less than a year ago and is showing features of depression.
A 73-year-old patient of mine experienced a stroke eight months ago. She remains at home living independently but has almost total paralysis of the right arm, which she wears in a sling, and minor dysphasia. At her last visit, she was far less cheerful than usual, had lost 3 kg in weight, and told me she was always tired. Screening blood tests failed to reveal any abnormality. I suspect she is depressed and wonder if the depression is likely to be a direct result of the cerebral damage or a reaction to her disability. Also, should I treat this woman with an antidepressant and is any class of agent preferable over others in this situation? She is taking low dose aspirin and an antihypertensive agent.