Survivors of stroke experience many changes resulting from their illness. Most people are aware of the physical changes that occur following stroke, for example paralysis or weakness on one side of the body, or difficulty with speech and language comprehension. However many people also experience some changes in their mood. For some these changes last for a short time, yet others may have ongoing problems.
One quarter to half of all survivors of stroke will experience some degree of depression and/ or anxiety. However many people suffering from depression or anxiety are unaware that they are unwell.
This also means they cannot tell their families, caregivers or doctors that they need help. Because of this, many people who experience mood changes after stroke (like depression and/ or anxiety) do not receive treatment.
Major depression is likely to be noted and treated by a health professional but milder depression or anxiety may not be recognised. Some people may think they are feeling down because they have been ill, unable to work, or maybe having difficulty with day to day activities. This is a common reaction to changes in health, but should only last for a short time. Other people believe their changes in mood are a natural part of the ageing process. It may be even more difficult to recognise depression in people who have difficulty communicating and understanding.
Recognising and receiving treatment for depression following stroke is important. Depression can slow recovery from stroke and other illnesses, delay resumption of social and physical activities, and add to stress of families and caregivers (it is not uncommon for caregivers to suffer from depression also).
What Causes Depression
After stroke, there are probably two main causes of depression: Psychological and Biological
Psychological Cause: This is the feeling of sadness and sorrow that may follow a stroke. Your brain attack may have dramatically changed your life. You may feel sad about the lost abilities and grieve as you would over the loss of a friendship or death of a relative. Minor feelings of depression about lost abilities is common during your recovery as you learn to live with the effects of a brain attack.
Biological Cause: This is often a more severe type of depression related to damage to the brain following stroke. The symptoms are often the same as for a psychological depression and therefore can be difficult to diagnose. The difference is that a biological depression results from how the brain works after it has been injured, whereas the other is a psychological response to disability and loss. Where and how much of the brain has been injured has a lot to do with whether you experience severe depression after stroke.
If you or someone you know, have had any of the changes listed below over a persistent period, you may wish to seek advice from a doctor, nurse or other health professional. There may be an important underlying emotional problem.
It can of course be uncomfortable or embarrassing for some people to discuss their emotions. However, your doctor, nurse or health professional is trained to help with such matters and will be able to explain things clearly and answer any questions you may have. If you have any concerns for yourself or someone close to you, it is important that you tell someone. Only then can you receive the help, support and treatment that you may need.
Features of Post-Stroke Depression
Changes in sleep: unable to sleep, or sleeping for a long time, always feeling drowsy.
Changes in your appetite/weight: Either increasing or decreasing.
Changes in mood: often in a bad mood, feeling irritable or sad.
Changes in energy: often feeling tired and unable to finish things you started to do.
Loss of interest: in work, hobbies or sex.
Feelings of restlessness: sometimes laughing or crying when you do not expect it.
Feeling down: feeling guilty, worthless, suicidal or depressed.
Difficulty concentrating: often difficulty completing tasks, making decisions or talking.
Loss of confidence: fear of leaving the house, crossing the road or being alone.
Revision date: June 21, 2011
Last revised: by Janet A. Staessen, MD, PhD