Mental Health After Stroke

Alex Alverson, Ph.D., ABPP, clinical neuropsychologist in Shepherd Center’s Brain Injury Rehabilitation Program

By Alex Alverson, Ph.D., ABPP, clinical neuropsychologist in Shepherd Center’s Brain Injury Rehabilitation Program

Almost 800,000 people in the U.S. experience a stroke every year. While the most obvious symptoms are often physical or cognitive (e. g., problems with moving or speaking), many people who have had a stroke will also experience changes in mood and behavior. Injury to specific brain regions can lead to these changes, or they may come from changes in lifestyle, roles, and abilities.

Treatment for mood changes isn’t always necessary because feelings like grief, sadness, and worry are normal responses to a significant life event like a stroke. However, when these symptoms are chronic and severe enough to impact daily functioning, a person may have a mood disorder. At least one in three people affected by stroke is diagnosed with depression within five years after a stroke, and one in five is diagnosed with an anxiety disorder. Because mood disorders can interfere with rehabilitation and increase disability, recognizing and treating these symptoms is important for recovery. Many people affected by stroke can benefit from psychological and/or psychiatric treatments.

Symptoms of depression and anxiety may be different for different people and often overlap. Some of the most common symptoms are listed below.

Treatment

Interventions for mood disorders may include psychological treatments (e.g., psychotherapy), behavioral and environmental modifications, and medications. Psychotherapy involves working with a licensed mental health provider (e.g., psychologist, licensed professional counselor) and may focus on setting goals, solving problems, improving relationships, acceptance, relaxation, and meditation, or changing unhelpful patterns of thinking. Some individuals who have had a stroke may not be able to participate fully in psychotherapy due to problems with memory, language, or reasoning. Fortunately, creating a supportive and positive environment and engaging in pleasant activities positively affects mood.

Your medical doctors (e.g., psychiatrist, neurologist) may also prescribe medications to treat mood disorders. These medications work by targeting chemical changes in the brain after stroke. For example, antidepressants increase the activity of chemicals related to motivation and drive. All of these interventions can be effective in reducing symptoms of depression and anxiety, but they work best in combination.

What can you do in the hospital or at home?

Medical providers and members of the treatment team can work with patients and caregivers to generate strategies for managing or responding to changes in mood. Some recommendations might include:

• Encourage and allow for rest and quiet time.
• Orient the person to the situation (such as day, time, place, and activity).
• Maintain structure and routine in daily schedules.
• When someone is outside their usual environment, keep familiar items nearby, such as photographs, mementos, and special clothing.
• Validate emotions. There is no ‘right’ or ‘wrong’ way to feel when recovering from a stroke.
• Spend time on enjoyable activities and socialization. Feeling engaged and connected to others can improve mood.
• Focus on concrete, short-term, achievable goals.

If you or a loved one is concerned about changes in mood, be sure to talk to your medical providers. You are not alone!

Sources:

https://www.stroke.org/en/about-stroke/effects-of-stroke/emotional-effects-of-stroke

Post-Stroke Depression: A Review, Robert G. Robinson and Ricardo E. Jorge, American Journal of Psychiatry 2016 173:3, 221-231