Can a Stroke Cause Depression?

Each year, around 795,000 people in the United States have a stroke. While more than 82% of those people survive, many face a variety of issues during rehabilitation.

Some face physical challenges, like having to relearn how to walk, talk, eat or write in order to regain independence. But other challenges are invisible and can be more difficult to identify.

“Some degree of depression occurs in approximately 40% of persons with acute stroke,” notes Kelsey Hanson, a nurse practitioner who sees patients at the Stroke Clinic at Harborview Medical Center.

Here’s why depression affects stroke survivors so much and what medical experts are doing to help.

Post-stroke depression is common

About one-third of all stroke survivors have depression at some point during their recovery. That’s three times as common as it is in the general population.

If you’re a woman, your risk may be even higher. According to a recent study comparing stroke survivors who are 65 or older, women are 20% more likely to develop post-stroke depression than their male counterparts.

How and why post-stroke depression affects women differently than men is not well understood, Hanson notes, but it’s likely due to a combination of factors ranging from hormone differences to social roles.

One study found that while women are more likely to survive an ischemic stroke than men, they also experience more disabling conditions and have a poorer quality of life afterward.

“Approximately 25% of patients who have a stroke have some level of cognitive impairment within the first three months post-stroke,” Hanson says. “Stroke survivors with cognitive impairment have higher rates of disability, mortality and longer hospitalizations, all of which can lead to depressive symptoms.”

What causes post-stroke depression?

Why exactly do some stroke survivors develop depression? Because of how a stroke impacts a combination of psychosocial and biological traits, Hanson explains.

“In some cases, a person’s language may be affected and that impacts their ability to communicate and express themselves,” she says. “This change can be frustrating for patients and they may feel isolated or not able to find joy in things they did pre-stroke.”

For others, the struggle may be more about dealing with the physical effects of a stroke.

“A stroke may cause weakness or sensory changes on one side of the body that makes dressing, bathing, feeding and toileting difficult and some patients may feel embarrassed or a loss of dignity and independence by needing help,” Hanson notes.

And for other survivors, damage to the brain might be the catalyst.

“A stroke in the left hemisphere has been associated with higher rates of depression and may be related to the effects the left hemisphere has on language and cognition,” Hanson explains.

What are the symptoms of post-stroke depression?

As with general depression, the symptoms of post-stroke depression can manifest in a variety of ways.

“You may have a loss of pleasure or interest in doing things, depressed mood, minimal social engagement, changes in appetite, changes in weight, excessive sleep, inability to concentrate, feelings of worthlessness or hopelessness and thoughts of self-harm,” Hanson says.

With post-stroke depression, however, it may be even more difficult to voice and identify those symptoms.

For example, patients who lose their ability to speak or have other neurological issues may not be able to easily express themselves and their feelings.

That’s why the American Stroke Association suggests health care providers screen for depression based on other factors, such as a survivor’s willingness to participate in post-stroke therapy.

How do you treat post-stroke depression?

While depression after a stroke is just one more issue to deal with during an already difficult time, it is manageable.

Hanson says the best way to tackle your post-stroke depression is to talk with your medical team and support system.

“Engage with rehabilitation therapies as soon as possible,” she says. “Talk to a counselor, your health care providers, close friends or family. Join a support group. Share your needs and ask for help.”

The road to recovery may not be an easy one, but with time — and help — there is a path forward.