After a stroke, decades of severe depression vanished
My mother suffered from severe recurring depression for 30 years, episodes that floored her to the point of near-catatonic inertia. She was lost to us in a mire of desolation. This happened often — once a year, sometimes more. She endured hospital stays, electroconvulsive therapy, countless appointments with shrinks, dozens of prescriptions.
Then, 2½ years ago, she had a stroke. It stole her ability to read, her ability to remember names, her right-sided vision. It also stole her depression.
Until the moment she had her stroke — a massive brain trauma to her left occipital lobe — Mum had been in a major depressive episode that had endured for two years, the longest stretch ever. Yet in the post-stroke rehab ward, I find her engaging with other patients in a way she has not done for years. She is animated — her speech, unlike her reading, quite unaffected by her brain injury — the antithesis of the lethargy that hamstrung her for so long.
Will it last, I ask her neuro. Nope, he says, adamantly and assuredly, with a finality I dare not argue with. He’s the expert, after all. But I am disappointed. And afraid.
Months pass, and Mum learns to navigate within the confines of her narrowed vision: She bumps into chairs less often, knocks fewer coffee mugs flying. She relearns to read a little. “I’m so slow,” she says impatiently. We encourage friends and family to write her short, tight emails. Less overwhelming that way, I tell them. She even begins to tackle a book. But she doesn’t learn to remember names. In fact, I notice, her memory loss is not limited to names of people and places. It is unreliable and potholed. Some memories hold fast, others have come quite adrift so that they vanish.
She gazes at the tablets I count into her pillbox. Tablets to sweep veins of clogging debris, tablets to keep her blood flowing, the two work to minimize stroke risk, I explain. “And what are these?” she wants to know, plucking a big red capsule from the tray. “Venlafaxine,” I say, “for your depression.”
But I don’t have depression, she says, her eyes snapping up at me. She cannot be sure what she had for lunch yesterday, but she is quite certain she does not have depression. Never has.
I am staggered. My mother has been on a cocktail of antidepressants and anti-anxieties for as long as I can remember.
And now, 2½ years after her stroke, she is happier than I recall seeing her in 40 years. Where did the depressions go?
Could it be, I ask Karen Postal, a clinical instructor of neuropsychology at Harvard Medical School, that the loss of memory means she can’t hang on to her anxieties; she can no longer ruminate?
This is possible, she agrees. But, she reminds me, “depression is not just an emotional state, it’s a thinking state, it’s about habits of thinking” — translating, misconstruing, misreading, misunderstanding “and, yes, ruminating.” So, if my mother’s cognition was hijacked — for along with her rightsided vision loss and those proper nouns, her brilliant intellect is gone, and I must explain the simplest of things to her now, in the simplest of terms — that means her thinking habits, good and bad, have been derailed.
My mother’s neural circuit board suffered a short. A fizz and a pop, the lights went out and the electricity had to be rewired. Her depressions vanished not, it seems, because of the part of the brain that was affected but because the cognitive routes her brain once took have had to deviate.
She thinks differently, so she is different. Different without depression.