When Dr. Amytis Towfighi saw that Sen. John Fetterman (D-PA) had been hospitalized for depression, as his office announced Thursday, she wasn’t surprised.
“About one in three stroke survivors develop depression at some point after their stroke,” she told The Daily Beast. (The Cleveland Clinic estimates a slightly more conservative range of between 10 and 27 percent.) “It’s quite common. It’s something that, as stroke neurologists, we’re always on the lookout for.”
In 2016, Towfighi, a professor of neurology and population and public health sciences at USC’s Keck School of Medicine, chaired a writing group for the American Heart Association that worked to publish a scientific statement on post-stroke depression. The statement outlined what was known about the condition, what knowledge gaps remain, and how best to treat it. That’s the bottom line, according to Towfighi: Though symptoms can vary widely and are different in every patient, post-stroke depression should be approached like any other medical condition.
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“It’s treatable and able to be managed,” she explained.
Fetterman, elected as Pennsylvania’s senator last year by a five-point margin over his opponent Dr. Mehmet Oz, is currently receiving treatment at the Walter Reed National Military Medical Center “on a voluntary basis,” his chief of staff, Adam Jentleson, said in a statement. “John is getting the care he needs, and will soon be back to himself.”
With treatment and time, there’s no doubt that Fetterman should be able to return to the demanding job of being a U.S. senator, according to Dr. David J. Hellerstein, a professor of clinical psychiatry at Columbia University and a research psychiatrist at the New York State Psychiatric Institute. “There’s a lot of very accomplished people, people with authority and decision-making power, who have mood disorders,” he told The Daily Beast. “Depression is a chronic and recurrent condition, but a lot of people are able to function in their adult lives with whatever symptoms they have.”
That said, learning to cope with depression is hard enough without also being in recovery from a stroke. “Stroke recovery is a long process,” Towfighi said, “But the wonderful thing about stroke and the brain is that the brain is constantly creating new networks. So one thing that I can always tell my patients who've had a stroke is that you're going to get better, and I know that they will get better, but it requires a lot of therapy. It’s a long road that requires a lot of patience.”
It’s not definitively known what links a stroke to clinical depression, whether it’s biological, psychological, or some combination of the two. Some of a depressed person’s symptoms—low energy levels, change in appetite or sleep patterns, and suicidal ideation—can also be confused with those of someone recovering from a stroke, making depression easier to miss.
“When you look at the whole picture, the whole constellation of symptoms,” she added, “and somebody has a lot of them, then that’s really suggestive of depression.”
In Fetterman’s case, it’s unclear when exactly his condition was detected. He has “experienced depression off and on throughout his life,” according to Jentleson, but only “in recent weeks” did it become “severe.” Besides the more general stressors related to life as a freshman senator, a factor that might have impacted Fetterman’s mental health could have been the auditory processing issues that have surfaced in the wake of his stroke. Especially when stressed or confused, The New York Times reported last week, his condition worsens, causing human voices to fuzz until they resemble the muted-trombone sound of the teacher in the Peanuts cartoon.
“If people are having trouble understanding, or having difficulties expressing themselves… it can be very frustrating,” Towfighi said. “So it could definitely contribute to depression.”
Besides psychotherapy and medication, what best helps people living with depression are their social support networks. One pillar of that network for Fetterman will be his wife, Gisele Barreto Fetterman, who tweeted on Thursday that she was “so proud of him for asking for help and getting the care he needs.”
Other sources of support will be his colleagues, like Sen. Tina Smith (D-MN). “In the short time I’ve worked with John Fetterman, I’ve been struck by his resilience and heart,” she posted to Twitter after the news of his hospitalization. “John is doing exactly what he should do, which is seek help.”
She continued: “Seeking help when you need it is a sign of strength, not weakness, something that John is demonstrating for all of us.”
That was one of the things Towfighi found “heartwarming” about the matter, she said. “He wasn’t hiding it, and there was no shame.”
To come out and articulate what you’re struggling with is “a step towards destigmatizing” it on a wider scale, Hellerstein added. He lauded people with followings for coming forward with their own stories, be they of depression, other mood disorders, or substance dependence problems. “It’s a public good, frankly,” he said.
