Emotional issues and depression

Being a stroke survivor can be emotional

They say every stroke is different. But people don’t fully realize that every stroke is also complex and messy. Mixed in with those symptoms are emotions -- like confusion, frustration, anger, denial, resentment, grieving, anxiety, and sadness. This can make the therapist's and the doctor's job harder but ultimately  more rewarding.

Only a very few stroke survivors and their caregivers receive information or advice about the emotional impact of having a stroke. But two-thirds of patients suffer depression and anxiety. And almost half of stroke survivors feel abandoned when they leave the hospital.

Approximately 20-30% of stroke survivors experience clinically significant levels of anxiety at some point after stroke.

A study found that one in four stroke survivors report experiencing  anxiety two to eight weeks after their stroke, with incidence more common in women and those who are single, divorced or widowed.

The researchers analyzed the health records of 194 ischemic stroke survivors. They found that 32 percent of women and 21 percent of men reported moderate to severe anxiety. The patients with this level of anxiety were significantly more likely to be single, divorced, or widowed than those without moderate to severe anxiety.

Emotional lability / PBA 
Emotional lability is a condition that causes sudden and unpredictable episodes of crying, laughing or other emotional displays. It is also called involuntary emotional expression disorder (IEED), emotional incontinence, or pseudobulbar affect (PBA). About 38% of stroke survivors have had PBA. 

Many stoke survivors experience it. It is thought to impact more than 1 million Americans who are stroke survivors or survivors of other traumatic brain injury or neurological diseases.
There are things you can do to cope with emotional PBA:
  • Tell people that you cannot always control your emotions and that the emotions you show on the outside don’t always reflect how you feel on the inside.
  • Distract yourself. If you feel an emotional episode coming on, try to focus on something unrelated.
  • Note the posture you take when crying. When you think you are about to cry, change your posture.
  • Breathe in and out slowly until you are in control.
  • Relax your forehead, shoulders, and other muscle groups that tense up during an emotional episode. 
Talk with your doctor about medications. Nuedexta is a new drug especially for PBA. Some antidepressants can help too, with citalopram (Celexa) being especially beneficial. (And they even might help stroke patients improve movement and coordination!)

Visit this website for more information on PBA or this site.

Depression can be caused as an understandable response to the loss and impairment that a stroke produces. It can also caused by biochemical changes in the brain caused by the stroke.

While the risk of post-stroke depression is highest the first year, we also know that about 55 percent of people who've had a stroke will develop depression at some point,. "A stroke often damages the amygdala, a part of the brain involved in regulating emotions. It also reduces levels of brain-derived  protein that affects mood, and raises levels of the stress hormone cortisol. All of this combines to create a potentially persistent, disabling depression. And depression is associated with poorer recovery after stroke and a higher risk of dying. See Neurologic Conditions Can Lead to Depression.

Whatever the cause, it is important to address it. Almost 70% of survivors with depression are not treated a full year after their stroke. Depression is especially common with people who have aphasia, as is article points out: But it's important to not confuse depression with sadness.

The symptoms of post-stroke depression may vary and change over time, but -- as this article notes -- patients and families should watch for:
  • Persistent sad, anxious, or “empty” mood
  • Depressed mood; loss of interest/pleasure
  • Sleep disturbance
  • Decreased motivation
  • Feelings of hopelessness, pessimism
  • Feelings of guilt, worthlessness, helplessness (feeling like a burden)
  • Decreased energy, fatigue, being “slowed down”
  • Difficulty concentrating, remembering, making decisions
  • Appetite disturbance
  • Thoughts of death or suicide
When five or more of the above symptoms persist for two or more weeks, a survivor may be experiencing post-stroke depression.

Things you can do:

Emotional lability / PBA  vs. Depression
For the differences, see this chart:

Tips to help you deal
The following  tips come from a StrokeSmart article:
  • Don't feel guilty about your feelings. They’re not good or bad. They’re a normal part of the recovery process.
  • Talk to someone. Talking about the stroke and your feelings about it will help you come to terms with them.
  • Join a support group. Other survivors will understand what you’re dealing with and can offer insight.
  • Know when to ask for help. Talk to your doctor if you think you could benefit from counseling or from an antidepressant.
  • Exercise. It’s a natural mood booster and will help you feel better.
  • Find time to relax. Listen to music you enjoy, meditate, or practice deep-breathing exercises. These can be particularly helpful if you feel anxious. Writing your worries on a piece of paper also can help. 
  • Do something you enjoy, whether that’s watching a silly television show, spending time with your family, or savoring a good cup of coffee.
  • Give yourself credit. It’s important to celebrate your progress and it’s OK to make mistakes.
  • Tell people how you’d like them to treat you if you become emotional. You might get more upset if someone dismisses your feelings or tells you not to cry.


Other Behavioral Changes