Mood Swings Post-Stroke: Understanding The Emotional Rollercoaster

can you get mood swings after a stroke

Experiencing mood swings after a stroke is a common phenomenon. The stroke survivor may exhibit a range of emotional and behavioural changes, including irritability, forgetfulness, carelessness, inattention, confusion, feelings of fear, frustration, anger, grief, sadness, anxiety, and depression. These mood swings can be attributed to biological changes, such as damage to the emotional centre of the brain, or lifestyle changes, like alterations in routine or sleep disturbances.

One specific condition that can arise after a stroke is pseudobulbar affect (PBA), which is characterised by sudden and unpredictable emotional outbursts that don't align with the situation at hand. For instance, a person with PBA might find themselves laughing at something sad or crying at something funny. This condition can be a result of damage to the connection between the frontal lobe and the brainstem or cerebellum.

It's important to recognise and address these emotional changes, as they can significantly impact the quality of life for both the stroke survivor and their caregivers. Treatment options are available, including medication and therapy, and social connections have also been shown to help with post-stroke depression and anxiety.

Characteristics Values
Emotional Changes Depression, anxiety, anger, frustration, lack of motivation, crying or laughing for the wrong reasons, irritability, forgetfulness, carelessness, inattention, confusion, fear, grief, sadness, apathy, impulsiveness, pseudobulbar affect
Physical Changes Changes in how you move, speak, or see
Lifestyle Changes Changes in routine, sleep disturbances, chronic fatigue, inability to participate in hobbies

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Pseudobulbar Affect (PBA)

PBA can cause sudden, unpredictable changes in emotions, and those affected may feel like they have lost control over the link between their feelings and how they express them. These changes can be challenging to live with, but there are treatments available. Medication can help, and it is recommended that people with PBA explain their condition to those around them, to help manage expectations and reactions. Other techniques for managing PBA include focusing on something else when an outburst is coming on, relaxing, and slowing down breathing.

PBA is just one of several emotional and behavioural changes that can occur after a stroke. Depression and anxiety are common, as are anger, frustration, and a lack of motivation. These emotional changes can affect a person's quality of life and their recovery, so it is important to seek help and support.

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Depression

Signs of depression

  • Feeling sad, empty, irritable, helpless, or hopeless
  • Problems sleeping (too much or too little)
  • Changes in appetite
  • Loss of interest in things once enjoyed
  • Spending less time with people
  • Feeling tired or having headaches or pains that don't get better with treatment
  • Suicidal thoughts

Getting help for depression

It is important to let your doctor know how you are feeling so they can suggest appropriate treatments. Counselling or therapy with a licensed mental health practitioner is recommended, as are medications and cognitive behavioural therapy. Joining a support group can also help, as can staying active and exercising.

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Anxiety

There are many reasons why a survivor may experience anxiety after a stroke. Survivors frequently experience anxiety related to their health, such as having a second stroke or feeling unable to communicate during an emergency. Other common worries include embarrassment in social situations, the inability to drive, and never feeling better or improving.

There are various interventions for anxiety after a stroke. Seeking information by talking to a doctor or psychologist about your feelings can help increase your sense of control. Additionally, support from friends, family, and community groups can help you feel less alone. Mindfulness techniques, such as focusing on the present moment and practising meditation or deep breathing, can also help manage anxiety. Cognitive-behavioural therapy (CBT) is another effective treatment for anxiety, focusing on uncovering unhealthy thinking patterns and providing helpful coping strategies.

In some cases, medication may be beneficial in relieving anxiety symptoms. Commonly prescribed medications include antidepressants, benzodiazepines, and antihistamines. However, these are usually used on a short-term basis, as long-term use can lead to dangerous withdrawal symptoms and addiction.

It is important to talk to your doctor if you are experiencing persistent symptoms of anxiety, as they can help you manage your condition and improve your mental and emotional health.

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Anger

Some people feel angry for no reason, or get angry about things that didn't bother them before their stroke. They may find it hard to control their temper, which can affect their well-being and recovery. Anger can also be difficult for those around them.

If you or someone close to you feels that anger is affecting your life, it's a good idea to talk about it or seek help.

Factors associated with post-stroke anger include motor dysfunction, dysarthria, high National Institute of Health Stroke Scale scores, previous stroke, premorbid neuroticism personality trait, history of depression, and low monoamine oxidase A activity.

SSRIs such as fluoxetine and citalopram have been found to be beneficial in treating aggressive behaviour in patients with personality disorders or dementia. Beta adrenergic antagonists and lithium may also reduce aggressiveness in patients with brain injuries.

In one study, fluoxetine therapy significantly reduced anger scores in patients with subacute stroke. Another study found that escitalopram was effective in preventing anger when administered during the acute stage.

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Apathy

A recent meta-analysis of 24 studies found that apathy occurs in 29.5% to 40.2% of patients after a stroke and is typically associated with worse disability and enduring cognitive deficits.

A study of 213 patients admitted to a stroke-specialized acute rehabilitation unit in the United States found that 21% had persistent apathy. Patients with apathy were 2.4 times more likely to go to a nursing home and had discharge FIM scores 12 points below the mean.

Another study of 96 patients undergoing acute rehabilitation for stroke found that 28% had apathy. Apathy severity was not normally distributed, as 44% of patients had a score of zero (i.e. no signs of apathy). Apathy severity generally improved during acute rehabilitation but only to a small degree, and the majority of apathetic patients remained apathetic at discharge.

Frequently asked questions

Emotional changes after a stroke can include pseudobulbar affect (PBA), anxiety, depression, anger, frustration, and grief.

PBA is characterised by a mismatch or exaggeration of feelings and expressions, like crying at a joke or laughing at a funeral.

Anxiety can make you feel panicky, irritable, or restless. You might sweat more, have a fast heartbeat, headaches, nausea, feel shaky, and get short of breath. Depression can make you feel sad, empty, irritable, helpless, or hopeless. You may have problems sleeping and changes in appetite. You may lose interest in things you once enjoyed and spend less time with people you care about.

You may talk and act angry, or shut down and not share how you're feeling. Some people will become aggressive after a stroke.

It's important to let your doctor know how you're feeling as you recover. They can suggest treatments such as medication and therapy. You can also try finding a support group, staying active, eating well, and practising relaxation techniques.

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