As far back as Hippocrates (approx. 460BC-377BC) it was known that change was strongly connected to illness. Human beings will try to avoid change as much as possible, as you will undoubtedly recognise in the way you choose to run your own life. We are especially vulnerable to change that occurs rapidly and without our "consent" - as it were. Is it then surprising that someone would become unwell, in an emotional sense, in response to change that has left them feeling helpless and despairing? Powerless to change their situation.

It is now acknowledged by clinicians working with depression that the psychology that accompanies helplessness can be a significant contributing factor. A stroke presents the individual and his/her family with an existential crisis. One that will be with them for an indefinite period of time. As motivation wanes and the sense of optimism begins to erode, those involved will begin to experience a collective sense of helplessness and despair. The dilemma that is posed by the depressed mood associated with such a profound life event, is whether or not it should be treated medically, and in fact will the medical treatments available be of benefit?

The effects of a stroke are both physical and psychological. The neurological damage can of course affect concentration and memory. These are known symptoms of depression but are also side-effects of a stroke. Feelings of despair and helplessness are also symptoms of depression but are also very understandable responses to having your life tipped upside-down. When speaking with Wolfgang he describes not feeling clear enough in his own mind to be able to determine whether or not he was depressed. Hence he did not feel that he would have been able to make decisions regarding the appropriateness of introducing a medical treatment regime for depression.

I went on to ask him whether or not he felt that it was the responsibility of the family, at this stage, to move ahead with such decisions. He pointed out, and I agree, that the whole family is in shock, they are battling with their own upsets, their own emotions, their fears, their own sense of despair and helplessness. Hence would they in fact be able to make an informed judgment call?

In such a complex life situation there are no hard and fast rules. Everybody involved is learning as they go along and making mistakes at the same time. That will involve getting frustrated, feeling angry and feeling sad, with each other, at each other and at the situation. The cloud of helplessness will at times cast it's gloom without discretion. So you do the best that you can do - don't be hard on yourselves!

So, the question still remains. "Do you seek treatment for the depressed response.?" I would suggest that, as the strokee, if you start to lose any last thread of hope and your thoughts become actively suicidal, then you should seek professional help. I have emphasised "actively" because there is an important distinction between, thinking that it would have been easier on everybody if you had not survived the initial trauma, and engaging in thoughts that involve planning ways to kill yourself. It is the latter that is considered "active suicidality" and needs to be addressed.

Should the treatment intervention be biological (medication) or psychological (counselling)? Often both will be required, however, this should be assessed by a mental health professional or your G.P. Because so many of the issues involved are the bed partners of a stroke; relationship problems, sexual dysfunction, feelings of worthlessness. I see it more as a both/and, rather than an either/or situation.

I would also like to make the point at this junction, that the points that I have outlined above also apply to the family members. They are not immune to the stresses that have been discussed, neither are they immune to a possible depression. It is important to take care of the caregivers. You need to be aware of your own emotional needs. Because coping with the effects of a stroke necessitates a certain amount of selfishness, and all the love in the world does not change that reality. The conflicts and frustrations that may occur within your relationship is not a reflection on you or your deficits. It is the reality of what is occurring. So rather than personalise and become a martyr take time out to look after yourself.

In a nutshell, each experience is very unique. What affects one person may not affect another. More resilient individuals may appear to adjust more smoothly, but it is all relative. You should avoid comparing yourself to others, it may well be that genetically you are more sensitive to depression and hence, it is an additional factor that has to be dealt with. Either way, judging yourselves is of no help whatsoever. And remember; "Behind every unrealistic expectation, lies hurt and disappointment So don't go looking for them!"