After a stroke, depression and anxiety a concern for many

Addressing depression and anxiety post-stroke is important and can play a major role in the success of therapies and recovery.

After a stroke, it’s not uncommon for survivors to experience depression or anxiety. Not only do the many immediate challenges facing survivors affect their emotional well-being, but physical and chemical changes in the brain can have an impact as well. Addressing depression and anxiety post-stroke is important and can play a major role in the success of therapies and recovery.

Brittny Wannemuehler, R.N., stroke patient navigator for Norton Neuroscience Institute Resource Center, explains some of the mental health challenges and treatments for stroke survivors.

After a stroke, what are some of the challenges people face?

The difficult thing about stroke that is different from other chronic conditions that affect your brain, is there is no time for adjustment. One day you are yourself, and the next day you’re not; it happens suddenly and there is no gradual progression that allows for grieving and/or coping.

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While everyone is different and has unique concerns after a stroke, there are some common issues that people may face:

  • Insurance coverage for increased medical care needs and new medications
  • Physical limitations
  • Cognitive limitations, such as short-term memory loss
  • Anxiety and fear about having another stroke
  • Role reversal — going from being the provider/caregiver to needing care from family members
    • Loss of independence
    • Loss of self-identity
  • Transportation challenges
  • Financial concerns
  • Concerns about being able to return to work and possible job loss
  • Inability to communicate effectively
  • Inability to maintain the life you once had

Related Content: African Americans are at higher risk for stroke, but better outcomes are possible

What are some of the factors that may influence a person’s mental health after a stroke?

About a third of stroke patients experience post-stroke depression. If a person had depression prior to having a stroke, his or her risk for depression following a stroke is even higher.

Depression and anxiety can play a role in recovery and therapy. Currently, there is research being conducted on the effects of antidepressants on therapy success. Depression or anxiety after a stroke may influence a person’s emotional state, and there is a risk of withdrawal and isolation.

Support after a stroke is crucial for patients because there are many things that need to be coordinated as follow-up after hospital discharge, including appointments, medications, and therapy; a patient’s new physical or mental limitations may make this difficult and overwhelming. Aside from supporting the patient’s recovery, family members and loved ones may observe depression or anxiety in a patient and should bring those issues up with a provider.

How are post-stroke depression and anxiety addressed?

Currently, we see all stroke patients in our outpatient stroke clinic. Between hospital discharge and outpatient appointments, we want to allow patients to work on their recovery through available therapies. In the outpatient clinics, our providers can then evaluate whether there are any lingering issues, including depression and anxiety. In addition, it is crucial for patients to see their primary care providers as soon as possible to manage stroke risk factors such as elevated blood pressure, cholesterol, and blood sugar levels, as well as address depression, anxiety, and any other issues affecting their recovery.

We refer patients for individual counseling and psychiatric needs. We encourage self-care, which includes getting involved in support groups offered by Norton Neuroscience Institute, as well as socialization, getting plenty of rest, and a well-balanced diet.

Related Content: New way to remember stroke symptoms: BE FAST

What resources are available to help stroke patients deal with challenges after a stroke?

The Norton Neuroscience Institute Resource Center offers a number of services to patients with neurological diagnoses, including stroke:

  • Stroke support groups: a general stroke support group and a support group for young stroke survivors
  • Exercise classes
  • Art and music therapy
  • Access to a social worker and disability representative
  • Transportation assistance screening
  • Screening for other community and government resources
  • A new Lego therapy program that was piloted for patients with multiple sclerosis but is now available for all neuro patients

With the changes and stress that come with caring for a loved one who has survived a stroke, caregivers and family members may also be at risk for depression, anxiety and feelings of being overwhelmed. Our stroke support groups are for survivors and their family members, friends and caregivers. Additionally, many of our classes and programs are open to caregivers. A social worker at the Norton Neuroscience Institute Resource Center can help connect caregivers to community resources and programs that provide respite care.

Do young stroke survivors face unique issues after a stroke?

When you have a stroke at a young age, your life can’t just stop. Patients may have children to care for or even parents who rely on their care. Young stroke survivors face the challenge of recovery after a stroke, including post-traumatic stress disorder (PTSD) and fear of having another stroke, while continuing to take care of everything else in their world.

Since young survivors are typically still employed, the ability to return to work and financial concerns can be overwhelming. Many young survivors have good physical recovery but struggle internally. People may expect young stroke survivors to be who they used to be because they appear to be back to normal, but the patient often feels different and not like themselves.

Often, young stroke survivors want to know why they had a stroke at such a young age, and the answer to that question can take some time to uncover. Young stroke patients may be burdened with feeling that they did something wrong to cause the stroke. As the stroke navigator, I help patients understand what they can do to prevent future strokes.

Another common issue among young stroke survivors is post-stroke fatigue. Our young stroke patients are used to being very active in their lives, but they may experience exhaustion that makes it hard to be motivated to get out and do things they’re used to doing. It is important to provide reassurance to these patients that post-stroke fatigue does generally improve with time.


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