My mother suffered severe recurring depression for 30 years, episodes that left her near catatonic.
This happened often – once a year, sometimes more. The worst episodes lasted months. She endured hospital stays, electroconvulsive therapy, countless appointments with shrinks, dozens of prescriptions, none a silver bullet.
Then, 2 1/2 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 of her stroke – a massive brain trauma to her left occipital lobe – Mum was in a major depressive episode that had endured for two years, the longest ever. Yet in the post-stroke rehab ward, she engaged with other patients in a way she had not done for years.
She is animated – her speech, unlike her reading, unaffected – the antithesis of the lethargy that hamstrung her for so long.
Will it last, I ask her neuro as he makes perfunctory rounds, unsmiling. Nope, he says, with a finality I dare not argue with. But I am disappointed. And afraid. Must Mum now learn to cope with depressions without her books – her refuge when sick?
Months pass, and Mum learns to navigate 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 short, tight emails. She even tackles a book. Some memories hold fast, others 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 minimize stroke risk, I explain. “And what are these?” she wants to know, plucking a 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 isn’t sure what she ate yesterday, but she is quite certain she does not have depression. Today she knows she never had depression. Tomorrow she may remember a little of the illness that stole decades of her life.
My mother has been on a cocktail of antidepressants and anti-anxieties for as long as I can remember. Sometimes they may as well have been crossed fingers, a rabbit’s foot, for all the good they did, but to stop them seemed reckless. Her illness was the knife edge upon which my family tiptoed.
Six months after Mum’s stroke and I notice a wobble. Her voice is teary, she lies in bed all day. I brace myself. On the third morning after the first tears, she is bright and smiling.
How are you? I ask nervously.
I’m fine, she says, cheerfully, in a tone that seems to say, “Why do you ask?” “How are you?” she adds. My Old Sick Mum never had the energy to care how anybody else was.
Turns out, she was just having a couple of bad days. My mum, who only ever had months of them at a time. Now, 2 1/2 years after her stroke, she is happier than I recall seeing her in 40 years.
Where did the depression go? Was her neuro wrong?
I scour the internet for “depression-free post-stroke,” but all I get are sites that describe depression that afflicts stroke patients. Could it be, I ask Karen Postal, a clinical instructor of neuropsychology at Harvard Medical School and president of the American Academy of Clinical Neuropsychology, that the memory loss means she can’t hang onto anxieties?
It is possible, she agrees, as confounded as I am. Postal says she has seen Alzheimer’s patients undergo a pleasant personality change, but never a stroke patient. She reviews medical literature, calls colleagues, but nobody has a definitive answer; there is no research to reference.
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 with her right-sided vision and brilliant intellect, that means her thinking has been derailed.
When the neuro in the rehab ward told me, “different part of the brain,” I envisioned a century-old phrenologist’s topography of the mind, as if each cerebral slice correlates to a different mood.
“The more sophisticated we get in our research, the more we recognize that brain function is holistic, interconnected by highly complicated networks working together to produce what we label as mood, thinking, language,” Postal says.
My mother’s neural circuit board suffered a short. 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.
