Sen. John Fetterman’s hospitalization for depression after his stroke raises questions about the connection. Here’s what we know

By John Bonifield, CNN

Democratic Sen. John Fetterman’s hospitalization for the treatment of clinical depression has raised questions about the links between depression and strokes — and how long he’ll need to be hospitalized.

The Pennsylvania Democrat, who suffered a stroke last May ahead of winning the Senate nomination, has experienced depression on and off throughout his life, according to his office, although it only became severe in recent weeks.

About a third of people who’ve had a stroke do suffer some sort of clinical depression. It could be for different reasons, including directly due to the impact on the brain from the stroke.

“There’s not a lot of data behind the reason, but one idea is that stroke itself messes up the brain’s ability to function well — not just the part of the brain where the neurons are affected by the actual stroke, but the way the different brain regions talk to each other. As a result, it can cause cognitive troubles, and that can impact the way we see and perceive the world and lead to depression,” Dr. Will Cronenwett, chief of psychiatry at Northwestern University Feinberg School of Medicine, said in a news release Friday.

It could also be more of a psychological impact from dealing with abilities that have been lost.

“A lot of people with stroke have to adjust to new reality of what their body and brain can do. And in some people that adjustment can lead to depression,” Cronenwett said.

Mental health experts told CNN that Fetterman’s prior history of depression likely increased his risk of post-stroke depression.

“We know that folks with a history of depression after they have a stroke, they’re at much higher risk of post stroke depression,” said Abigail Hardin, a rehabilitation psychologist and assistant professor at Rush University..

A source familiar with the matter told CNN’s Manu Raju last week that it’s unclear how long Fetterman might stay at Walter Reed National Military Medical Center. He could potentially stay for a month or so, the source said, or he could leave sooner than that, or maybe a little later. It will take time for him to get the right medication he needs for his treatment, the source said.

There is no general rule about how long someone hospitalized with depression should stay in the hospital, according to the Depression and Bipolar Support Alliance. Patients may stay a few days or as long as a few weeks.

“In someone who has pre-existing depression, it is possible that they may be more treatment resistant and have a history of failing medications. So as a result, they may require more aggressive treatment that can take several weeks and even into several months, depending on how they present,” said Dr. Daniel Bober, a psychiatrist in Hollywood, Florida.

“In someone who’s already had depression even before their stroke, this puts him at much greater risk and requires much more aggressive treatment,” Bober said.

Fetterman’s symptoms for depression included weight loss and loss of appetite, a source familiar with the matter said. He was not suicidal, the source said. His lack of eating and drinking water contributed to lightheadedness. He was hospitalized earlier this month in Washington, DC, after feeling lightheaded. His office said he had not had another stroke.

“Generally, the reason that someone presents to a hospital for a psychiatric condition like depression is because either they are acutely suicidal or they have been deemed unable to take care of themselves. And when I say unable to take care of themselves, I mean, their basic needs — food, hydration, hygiene — are all things that they’re required to do on a daily basis, and they are unable to do this due to the severity of their depression,” Bober said.

One reason to treat depression in the hospital is that care can happen faster. Doctors can try different approaches and pivot if something isn’t working, Cronenwett said.

Another reason is it’s safe.

“People with depression sometimes have trouble with activities of daily living. They may shut down or may stop eating. The hospital can support them in their activities of daily living. Some people may have thoughts about suicide, and the hospital can be a place of safety, while they are recovering,” Cronenwett said.

Care can consist of antidepressant medications as well as talk therapy.

“When we say talk therapy, we’re talking about different kinds of therapy, particularly cognitive behavioral therapy, also known as CBT. CBT has been shown to be very effective in combination with medication. And psychotherapy is an essential component to treat someone who has severe depression,” Bober said. “The good news is that there are very good treatments for depression and there are response rates that are as high as 80% of people within four to six weeks. So I am very hopeful that he will make a full recovery.”

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