Mental Health Effects of a Stroke

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What Is a Stroke?

A stroke, also known as a brain attack, occurs when a blood clot blocks the blood flow to the brain, or when a blood vessel in the brain bursts. The lack of blood flow to the brain means the brain doesn’t get the nutrients and oxygen it needs, which can cause lasting brain damage or long-term disability.

Mental Health Effects of a Stroke

The impact of a stroke on the brain can vary depending on which parts of the brain were affected and the type, severity, and number of strokes the person suffered.

People who have survived a stroke often experience emotional and behavioral effects, as well as adverse mental health effects, because stroke affects the brain and the brain controls emotions and behaviors.

As a result, people who have had a stroke may experience:

  • Depression
  • Anxiety
  • Pseudobulbar affect (i.e., uncontrollable laughter and crying)
  • Personality and behavior changes
  • Cognitive changes
  • Impaired communication abilities

Depression

Depression is very common after a stroke, says Hardik Amin, MD, a neurologist and stroke specialist at Yale Medicine. In fact, according to the American Stroke Association, between one-third and two-third of stroke survivors develop depression.

Depression can be caused by biochemical changes in the brain caused by a stroke, which can make it hard to feel positive emotions.

Depression may also be a normal reaction to the impairment and losses suffered after a stroke. It is particularly common in patients who have severe disability after a stroke, explains Dr. Amin. However, it can make the rehabilitation process harder for survivors.

These are some of the symptoms the person may experience, according to Dr. Amin:

  • Feeling sad, low, or worthless
  • Withdrawing from friends and family
  • Losing interest in things that they enjoyed in the past
  • Having reduced motivation and willingness to participate in rehabilitation, which is crucial for recovery
  • Experiencing fatigue, particularly in the early months following a stroke
  • Sleeping or eating more or less than usual

Treating depression can help improve the person’s physical, cognitive, and emotional recovery. Treatment involving counseling and medication can be very effective, according to Dr. Amin.

Dr. Amin recommends speaking with a primary care doctor or neurologist about depressive symptoms. He says healthcare providers also have screening questions to detect more subtle symptoms.

Hardik Amin, MD

Patients with strong support systems tend to do better compared to patients who are more isolated.

— Hardik Amin, MD

Anxiety

According to the American Stroke Association, approximately 20% of stroke survivors develop anxiety, sometimes in addition to depression.

These are some of the symptoms of anxiety the person may experience:

  • Feeling worried often, to the extent that it interferes with daily life
  • Having difficulty calming down or controlling anxious thoughts
  • Feeling tense, restless, or irritable
  • Experiencing physical symptoms such as rapid heartbeat, shortness of breath, dizziness, and unexplained aches and pains

Since strokes are often unexpected, many patients experience anxiety about the risk of a recurrent stroke in the future, says Dr. Amin. “Discussing treatment plans to prevent future strokes with healthcare providers may provide reassurance for patients with anxiety.”

Pseudobulbar Affect

Some stroke survivors may also experience pseudobulbar affect (PBA), in addition to depression and anxiety, particularly if they’ve experienced a brainstem stroke, although it can occur with other types of stroke as well.

This neurological condition is characterized by involuntary emotional expressions, such as:

  • Sudden, uncontrollable bursts of laughter, tears, or anger
  • Outbursts that are sometimes inappropriate to the situation (such as laughing unexpectedly in an important meeting or at a funeral)
  • Intense emotional outbursts that are difficult to restrain and often last longer than expected

Pseudobulbar affect is sometimes mistaken for depression, since people with this condition may cry a lot; so it’s important to seek diagnosis and treatment from a qualified healthcare provider.

Personality and Behavior Changes

In addition to mental health conditions, a person who has experienced a stroke may also display personality and behavior changes such as:

  • Irritability
  • Verbal or physical aggression
  • Lack of motivation
  • Repetitive behaviors
  • Impulsiveness 
  • Restlessness
  • Low frustration tolerance
  • Tendency to say or do things that are considered socially inappropriate

Cognitive Impairment

A stroke can also impair a person’s cognitive skills, affecting their thinking, memory, and perception, causing difficulty with:

  • Learning new skills
  • Planning and problem-solving
  • Being able to focus and concentrate
  • Orienting themselves per the day and time
  • Remembering recent events
  • Judging distances
  • Reading or watching television
  • Performing certain bodily movements
  • Recognizing objects, shapes, and figures, sometimes even their own body
  • Managing mobility, since they may not be able to see or feel on one side

Impaired Communication 

In certain cases, stroke can also affect the parts of the brain that control communication abilities, which can cause difficulty with:

  • Understanding what others are saying
  • Finding the right words
  • Speaking and forming words
  • Reading and writing

Changes to Everyday Life

In addition to physical and mental health effects, a person who has experienced a stroke may also experience changes to their daily life, such as:

  • Independence: The person may not be able to enjoy the same level of independence they had before, as they may not be able to care for themselves, manage their home, or perform functions such as driving.
  • Living arrangements: They may need to modify their home, require a caregiver, or have to move to a care facility.
  • Work: The person may no longer be able to work. 
  • Relationships: The person may experience sexual dsyfunction or may not be able to maintain relationships.

These changes can be difficult to cope with, but Dr. Amin says stroke support groups can be a great resource to meet others who are experiencing similar circumstances and symptoms. “Talking with other stroke survivors can remind patients they are not alone.”

In addition to reporting symptoms to a healthcare provider and seeking treatment, exercising, sleeping well, and maintaining social engagement can go a long way to improving mental health, says Dr. Amin.

A Word From Verywell

People who have survived a stroke may experience mental health conditions and changes in addition to physical impairment. Their day-to-day lives may also be affected. 

Fortunately, many of the disabilities, as well as emotional and behavioral changes caused by stroke tend to get better with time. Treatment and social support are crucial at this time, to help them cope and recover.

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10 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  5. Cleveland Clinic. Pseudobulbar affect.

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