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2012 ISSUE 1

Emotional Impact of Stroke

Even when physical effects diminish, stroke can have a surprising impact
on emotional wellbeing.

Finding the Way out of Post-Stroke Depression

In 2006, clinical social worker Flora Ingenhousz noticed during yoga practice that her right arm wouldn’t stretch out and there was a long delay between her thoughts and actions. Her husband drove her to the emergency room where a CT scan revealed a bleed in her left frontal lobe; she’d had a hemorrhagic stroke.

After months of physical, occupational and speech therapy, Ingenhousz was fortunate to have no physical residuals. But when her therapies ended she noticed the onset of post-stroke depression, a common factor with strokes affecting the brain’s left hemisphere.

Ingenhousz sought out antidepressant medication and a psychotherapist, and became active with the Montgomery County Stroke Association in Silver Spring, MD, serving on the board and using her own psychotherapy background to lead support groups for stroke survivors and caregivers. Ingenhousz has since overcome post-stroke depression and hasn’t had a depressive episode in more than two years.

In her support group work, Ingenhousz met nearly 100 stroke survivors. “Everyone had his or her own story and every month I learned about yet another way stroke can affect us—and how survivors cope,” she says. “Most of all, I learned about the resilience of the human spirit.”

What Tears Reveal

Stroke survivor Donna Pogue had no idea her uncontrollable crying had anything to do with stroke. Pogue, 59, had a stroke in 2010 and now struggles with pseudobulbar affect (PBA), a medical condition that causes unpredictable crying episodes.

She first noticed something felt off when she went to her fitness class and her heart rate was very high. Emergency room doctors couldn’t find anything wrong and sent her home the next evening. She woke up to hot flashes and double images of her husband bringing her coffee in bed.

“I called my best friend and started crying and crying,” she says. “She said ‘what is wrong with you?’ I said ‘nothing…everything,’” Pogue recalls. Giving in to her husband’s requests to go to the hospital, she tried to stand up and her right leg collapsed.

Doctors determined that clots had formed around the wire running from her built-in defibrillator to her heart, causing a stroke. She quickly regained function on her right side and says her biggest challenge today is remembering certain words and crying uncontrollably due to PBA. The condition impacts an estimated one million people in the U.S. and, Pogue says, is one of stroke’s lesser-known residuals.

Pogue says just looking at baby pictures of her kids will trigger an episode and that the best coping mechanism is distraction. “I’m learning to live with it,” she adds. “I try to stay positive and not think any sad thoughts.”

Identifying Post-Stroke Depression

Major depression, also known as clinical depression, occurs in between 25 and 40 percent of stroke survivors.

Symptoms of major depression include:

  • Continued sadness
  • Lower interest or enjoyment in usual activities
  • Lower energy
  • Difficulty concentrating
  • Lower appetite with weight loss
  • Sleep difficulties
  • Low self-worth or guilt
  • Isolating oneself from friends and life
  • Hopelessness about the future
  • Thoughts of death or suicide

Pseudobulbar Affect

Pseudobulbar affect (PBA) can include pathological crying and laughing and is triggered by damage to an area of the brain, sometimes caused by stroke. Because people with PBA may cry a lot, their symptoms may be confused with depression. The first step in treating PBA is to get an accurate diagnosis. Then ask your healthcare professional about ways to manage PBA.

The first and only FDA-approved treatment, Nuedexta, is a prescription medicine that can help PBA patients regain control of laughing and crying episodes.

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National Stroke Association’s mission is to reduce the incidence and impact of stroke by developing compelling education and programs focused on prevention, treatment, rehabilitation and support for all impacted by stroke.

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