Stroke's Mental Health Impact: Understanding The Unexpected

how can a stroke affect mental health

Experiencing a stroke can be a life-altering event, and it is understandable that it may affect one's mental health. A stroke survivor may experience a range of emotional and behavioural changes, as the brain controls our behaviour and emotions. These changes may include feelings of irritability, forgetfulness, carelessness, inattention, confusion, fear, frustration, anger, grief, sadness, anxiety, and depression. It is important to recognise and address these mental health concerns as they can interfere with rehabilitation and increase disability.

Depression and anxiety are common mental health disorders that can occur after a stroke. In fact, at least one in three people affected by stroke are diagnosed with depression within five years, and one in five develop an anxiety disorder. Symptoms of depression may include loss of interest, feelings of irritability, emptiness, tiredness, difficulty concentrating, changes in appetite and sleep, and loss of interest in sex. On the other hand, anxiety may manifest as constant worry or feeling anxious, difficulty calming down, trouble making decisions, tiredness, poor concentration, and sleep disturbances.

The impact of a stroke on mental health is not limited to the survivor but can also affect their family members and caregivers. It is crucial to seek help and support to manage these emotional and behavioural changes. Treatment options may include psychotherapy, behavioural and environmental modifications, medications, and support groups.

Characteristics Values
Emotional changes Shock, denial, anger, grief, guilt, irritability, forgetfulness, carelessness, inattention, confusion, fear, frustration, grief, sadness, anxiety, depression, despair, suicidal thoughts, loss of self, low self-esteem, low mood, loss of confidence, loss of motivation, loss of interest in sex, lack of energy, difficulty concentrating, difficulty sleeping, increased sleeping, loss of appetite, increased eating, difficulty controlling emotions, embarrassment, impulsiveness, apathy, pseudobulbar affect, delirium
Behavioural changes Aggressive behaviour, swearing, laughing at inappropriate times, crying, anger, loss of temper
Cognitive changes Memory problems, communication problems, language problems, reasoning problems

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Depression and anxiety are common after a stroke, with feelings of grief, sadness, and worry being normal responses

Experiencing a stroke can be a shocking and life-altering event, and it is completely normal for survivors to go through a range of emotions during their recovery. Depression and anxiety are two of the most common mental health issues that arise after a stroke, with feelings of grief, sadness, and worry being typical responses.

Prevalence of Depression and Anxiety After a Stroke

Depression and anxiety are frequently observed in stroke survivors, with approximately one in two survivors experiencing depression and one in four to five survivors experiencing anxiety. These mental health issues can arise at any time following a stroke, whether that be immediately after or months to years later. Moreover, they can affect not only the survivors themselves but also their family members and caregivers.

Risk Factors for Post-Stroke Depression and Anxiety

Several factors can increase the likelihood of developing depression or anxiety after a stroke. These include:

  • A history of depression or anxiety prior to the stroke.
  • Difficulty with communication and challenges performing everyday tasks.
  • A severe stroke.
  • Reduced independence following the stroke.

Symptoms of Post-Stroke Depression and Anxiety

The symptoms of depression and anxiety can vary from person to person but often overlap. Some common signs of depression include:

  • Loss of interest in previously enjoyed activities.
  • Feelings of irritability, being overwhelmed, emptiness, or numbness.
  • Persistent fatigue.
  • Difficulty concentrating.
  • Changes in appetite and sleep patterns.

On the other hand, common symptoms of anxiety may include:

  • Persistent feelings of worry or anxiety.
  • Difficulty calming down.
  • Trouble with decision-making.
  • Fatigue.
  • Concentration problems.
  • Sleep disturbances.

Impact of Post-Stroke Depression and Anxiety

Post-stroke depression and anxiety can have significant impacts on an individual's life and their recovery process. These mental health issues can interfere with rehabilitation efforts, increase disability, and negatively affect the individual's overall quality of life. They may also lead to a higher risk of stroke recurrence and mortality.

Treatment Options for Post-Stroke Depression and Anxiety

Treating post-stroke depression and anxiety is crucial for the individual's overall recovery and well-being. Treatment options typically involve a combination of psychological treatments, behavioral and environmental modifications, and medications.

Psychological treatments, such as psychotherapy, can involve working with a licensed mental health provider like a psychologist or counselor. This may include setting goals, improving relationships, learning relaxation and meditation techniques, and identifying and changing unhelpful thought patterns.

Behavioral and environmental modifications can include creating a supportive and positive environment, engaging in pleasant activities, and maintaining structure and routine in daily schedules.

Medications, such as antidepressants, can be prescribed by medical doctors to target chemical changes in the brain following a stroke. These medications can increase the activity of chemicals related to motivation and drive, helping to improve mood and reduce symptoms of depression and anxiety.

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Post-stroke depression and anxiety can interfere with rehabilitation and increase disability

Post-stroke depression and anxiety are common, with at least one in three people affected by stroke diagnosed with depression within five years after a stroke, and one in five diagnosed with an anxiety disorder. These mood disorders can interfere with rehabilitation and increase disability, so recognising and treating the symptoms is important for recovery.

Depression and anxiety can affect a stroke survivor's quality of life and their ability to function day-to-day. For example, people may lose interest in things they once enjoyed, feel tired all the time, and find it hard to concentrate. They may also experience difficulty sleeping, changes in appetite, and feelings of irritability and being overwhelmed. These symptoms can be chronic and severe, and in combination with physical and cognitive impairments, can make it difficult for stroke survivors to engage in rehabilitation activities.

If left untreated, post-stroke depression and anxiety can lead to increased disability. This is because the emotional and behavioural changes that accompany these disorders can make it difficult for survivors to participate in rehabilitation and can impact their motivation to recover. Additionally, depression and anxiety can affect a person's ability to perform activities of daily living, such as eating well, staying active, and socialising. This can further increase disability and slow down the recovery process.

It is important to seek help for post-stroke depression and anxiety, as they can have a significant impact on a person's life. Treatment options include psychological treatments such as psychotherapy, behavioural and environmental modifications, and medications. Creating a supportive and positive environment, engaging in pleasant activities, and maintaining social connections can also help to improve mood. By managing these disorders, individuals can improve their rehabilitation outcomes and reduce their disability.

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Changes in personality and mood after a stroke are common, with survivors experiencing impulsiveness, apathy, anger, frustration, and depression

Experiencing changes in personality and mood is common after a stroke, and these changes can be challenging for survivors and those closest to them. A stroke survivor may exhibit impulsiveness, apathy, anger, frustration, and depression, all of which can negatively impact their quality of life.

Impulsiveness, or acting without thinking, is often observed in survivors with right-side or front lobe stroke damage. This can lead to socially inappropriate behaviour, such as taking food from a stranger's plate or insulting people. It is a result of the inability to think ahead or understand the consequences of one's actions.

Apathy, or a lack of interest and drive, is another common consequence of stroke. This is different from depression, as those experiencing apathy may appear to not care about anything. Encouraging activity and movement can help individuals dealing with apathy. In some cases, an evaluation by a neuropsychologist may be necessary to determine the best course of treatment.

Anger and frustration are also frequently experienced by stroke survivors, who may exhibit increased irritability and get frustrated or angry more easily, sometimes even becoming physical in their anger expression. This can be a result of emotional feelings about the stroke itself, as well as brain injury to the frontal lobe, which controls emotions.

Depression is a significant concern, with about 30% of survivors developing it after a stroke. It can be caused by brain damage, the stress of adjusting to a "new normal," or both. Depression may manifest as fatigue, apathy, decreased concentration, or loss of interest in previously enjoyed activities. It is often accompanied by anxiety, which affects about 20% of survivors and can lead to withdrawal from social activities and physical symptoms such as shortness of breath.

It is important to recognise that these changes are common and that there is support available. Working closely with a healthcare team, including therapists and mental health practitioners, can help manage and improve these emotional and personality changes over time.

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Stroke survivors may experience emotionalism, where their mood changes very quickly and they are more emotional than usual

Experiencing emotionalism after a stroke is common, and it can be upsetting, especially if you were not an emotional person before. Emotionalism, or emotional lability, is when your mood changes very quickly, and you are more emotional than usual. You may find yourself crying or laughing more, or even laughing at something inappropriate. It can happen for no reason at all, and some people even start to swear when they did not before their stroke.

Emotionalism is most common in the early stages of a stroke, affecting about one in five people. It can be a sign of depression, but it can also happen on its own. If you are concerned about emotionalism, speak to your GP.

  • Crying or laughing for no reason
  • Expressing emotions more intensely than you feel them
  • Feeling like you have no control over your emotions, and that even the smallest thing can set you off
  • Having emotions that seem out of place or come and go very quickly

If you are experiencing emotionalism, there are treatments and therapies that can help. Your stroke team can offer advice and assess changes in mood. Depending on the problems you are having, your stroke nurse or GP may refer you to a mental health specialist, such as a psychologist or counsellor. Talking about the way you are feeling can help you understand and deal with it. Medication may also help.

There are different types of talking therapies available, and your GP may refer you to one. These include:

  • Cognitive Behavioural Therapy (CBT): This focuses on your thinking and behaviour and how they are connected. Negative thoughts can stop you from doing things, which can make you feel worse. CBT can help you break this cycle and improve the way you feel.
  • Interpersonal Therapy (IPT)
  • Mindfulness-Based Cognitive Therapy (MBCT)

If you are struggling with your mood or emotions after a stroke, remember that you are not alone, and there are people who can help you cope with the way you are feeling.

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Stroke survivors can benefit from psychological and/or psychiatric treatments, including psychotherapy and medication

Stroke survivors can benefit from a range of psychological and/or psychiatric treatments, including psychotherapy and medication. The most common psychological symptoms post-stroke include affective symptoms (sadness, anger, anxiety), behavioural symptoms (anger, crying, denial of disability), and cognitive symptoms (diminished attention, decreased memory, aphasia). The most common psychological reactions to stroke are post-stroke depression (PSD) and generalized anxiety disorder (GAD). PSD and GAD can occur early on or develop months or years after a stroke, and they may become chronic.

Psychotherapy

Cognitive-behavioural therapy (CBT) is a psychotherapeutic approach that helps individuals identify and change maladaptive thought patterns that negatively influence their behaviour and emotions. CBT can be delivered alone or in conjunction with antidepressant medication, or in group formats. It has been shown to decrease symptoms of depression and anxiety. However, there is a lack of high-quality evidence to support the use of CBT for treating post-stroke anxiety.

Other psychotherapeutic approaches that can be beneficial include problem-solving therapy, motivational interviewing, acceptance and commitment therapy, interpersonal therapy, and mindfulness-based interventions.

Medication

Pharmacological interventions for post-stroke mood disorders primarily focus on antidepressants. Selective serotonin reuptake inhibitors (SSRIs), selective norepinephrine reuptake inhibitors (SNRIs), bupropion, and tricyclic antidepressants (TCAs) have been found to be effective in reducing depression scores compared to placebo or standard treatment. However, antidepressants may cause side effects such as insomnia and sexual dysfunction, and they may increase the risk of intracerebral and gastrointestinal bleeding.

Combination Therapy

Combination therapy involving multimodal therapies and antidepressants may help prevent the development of PSD. Social support may also play a protective role in preventing the onset of post-traumatic stress disorder (PTSD).

Frequently asked questions

A stroke can affect a person's emotional wellbeing. It is common for survivors to experience feelings of shock, denial, anger, grief, guilt, irritability, forgetfulness, carelessness, inattention, confusion, fear, frustration, sadness, anxiety, and depression.

A stroke can cause changes in personality and mood, such as impulsiveness, apathy, pseudobulbar affect, and anger. It can also lead to delirium, which is characterised by an altered level of consciousness, disorientation, memory issues, and behavioural changes.

Yes, stroke survivors are at an increased risk of developing depression and anxiety disorders, including post-traumatic stress disorder (PTSD). At least one in three people affected by a stroke are diagnosed with depression within five years, and one in five develop an anxiety disorder.

Symptoms of depression may include loss of interest in enjoyable activities, feelings of irritability, emptiness or numbness, constant fatigue, difficulty concentrating, changes in appetite and sleep patterns, and feelings of worthlessness or guilt. Anxiety may manifest as constant worry or nervousness, difficulty calming down and making decisions, tiredness, trouble concentrating, and sleep disturbances.

Treatment for mood changes after a stroke may involve psychological treatments such as psychotherapy, behavioural and environmental modifications, and medications. Supportive therapies like cognitive behavioural therapy (CBT) and interpersonal therapy (IPT) can be effective. Creating a positive environment, engaging in pleasant activities, and socialisation can also positively impact mood.

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