A stroke survivor’s emotional health is just as important as his or her physical health and can promote or disrupt post-stroke recovery. Many stroke survivors experience feelings of anger, frustration, anxiety, sadness, fear and hopelessness in varying degrees. These emotions are common with post-stroke depression, which affects more than a third of stroke survivors. The National Institute of Neurological Disorders and Stroke characterizes post-stroke depression by a feeling of hopelessness that interferes with functioning and inhibits quality of life. If not treated and managed appropriately, post-stroke depression can slow down recovery.

Depression can set in weeks, months or even years after a stroke and can inhibit progress of recovery and rehabilitation, impacting a stroke survivor’s quality of life. A combination of factors can lead to post-stroke depression. The sudden nature of stroke can have a life-changing impact for many stroke survivors and their families. Damage to brain tissue after a stroke, genetics and social factors can also contribute to depression.

Symptoms

According to the National Institutes of Health, post-stroke depression is underdiagnosed. Symptoms of post-stroke depression vary in severity, frequency and duration for each individual. Caregivers, family members, friends and co-workers can be very helpful in recognizing post-stroke depression symptoms and encouraging the stroke survivor to consult with a healthcare professional.

According to the National Institute of Mental Health, signs and symptoms of depression include:

• Persistent sad, anxious or empty feelings
• Sleep disturbances
• Increase or decrease in appetite and eating patterns
• Feelings of helplessness, hopelessness and/or worthlessness
• Social withdrawal
• Loss of interest in activities or hobbies
• Irritability
• Fatigue
• Difficulty concentrating or remembering details
• Aches, pains, headaches and digestive problems that do not ease with treatment
• Suicidal thoughts

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Treatment

There are a variety of treatment options for post-stroke depression. Consult with a healthcare professional to determine the best course of action.

Medication

Antidepressants are common treatments for post-stroke depression and may be prescribed by a psychiatrist, primary care doctor or other physician. Antidepressant medications interact with chemicals in the brain called neurotransmitters to improve mood. The three neurotransmitters involved in depression are serotonin, dopamine and norepinephrine.

• Selective serotonin reuptake inhibitors (SSRIs) alter serotonin.
• Serotonin and norepinephrine reuptake inhibitors (SNRIs) increase the availability of serotonin and norepinephrine.
• Tricyclic antidepressants (TCAs) are older antidepressants that impact both serotonin and norepinephrine.
• Monoamine oxidase inhibitors (MAOIs) are the oldest antidepressant medication and are often used when an individual doesn’t respond to other treatment.

Mental Health Therapy

Medication is often combined with mental health therapy with a psychologist, psychiatrist, social worker or counselor. Cognitive behavioral therapy focuses on helping stroke survivors identify thoughts and feelings that lead to undesirable behavior. Sometimes post-stroke depression is fueled by other aftereffects of stroke, such as spasticity or aphasia. Physical or speech therapy can improve those conditions, and in turn help with post-stroke depression.

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Management

Treatment alone is not always enough to fight depression. A variety of practical management strategies can help fight depression and other difficult emotions.

If depression is left untreated and unmanaged, it can worsen a number of other common post-stroke conditions such as malnutrition, incontinence, pain, fatigue and sleep issues. Depressive emotions can increase when a stroke survivor is frustrated about not making progress in recovery.

Some tips to manage depression include:

• Communicate: Talking about feelings, post-stroke issues and concerns with caregivers, family and friends can be very helpful. Relationships may change after a stroke and it may take time to adjust to new roles.
• Improve nutrition: Foods rich in omega-3 fatty acids, folic acid, vitamin B and complex carbohydrates can help improve mood and fight depression.
  • Omega-3 fatty acids (fish, flaxseed, walnuts) promote brain health.
  • Complex carbohydrates (brown rice, oatmeal and whole wheat) boost neurotransmitter chemicals in the brain that affect mood.
  • Dark chocolate helps fight fatigue and reduce stress.
  • A deficiency in folic acid (beans, oranges, broccoli) is linked to depression; folic acid boosts neurotransmitters and promotes cognition.
  • Vitamin B12 (eggs, milk, liver) increases energy and alertness.
• Attend a stroke support group: National Stroke Association’s Stroke Support Group Registry lists hundreds of support groups throughout the U.S.
• Set realistic goals and prioritize: Break up larger tasks or projects into smaller ones.
• Practice stress and anxiety management techniques: Deep breathing, squeezing a stress ball, guided imagery, aromatherapy, meditation and taking a walk or journaling can be very helpful.
• Be patient with yourself and loved ones: Stroke can be traumatic and recovery takes time.
• Stay as active as possible: Adaptive equipment and aids such as canes, braces and walkers can help stroke survivors improve physical fitness. Walking, yoga and swimming are low-impact and promote recovery.
• Get out into the community: Volunteering for a cause you believe in, returning to work, taking cooking classes or joining a club can be exciting.
• Minimize or eliminate alcohol consumption and smoking.

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More Resources

Publications

• Careliving Guide
• StrokeSmart™ magazine

Fact Sheets

• Coping With Emotions
• Sleep Disorders

Multimedia

• iHOPE: Depression and Emotional Issues Post-Stroke
• Living After Stroke: Social and Physical Support for Returning to Work