Different Types, One Challenge: Depression After a Stroke

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  • June 3, 2011
Depression and Support after a Stroke

“I feel a sense of sadness and joy. Mostly sadness though about what I’ve experienced and sadness about what others have experienced in reference to the stroke.” –Luther Vandross

Stroke is one event that forever alters a man or a woman’s life. And once it occurs, it leaves a lasting impression. Numerous disabilities can result from that major event. Such impairments vary from speech deficits, physical disabilities, problems with cognition and many more. It even includes problems affecting moods and emotions.

And of all the areas of life which a stroke can affect, the shadow it casts on the stroke survivor’s personality is the most difficult to endure. Just like a bitter pill that one needs to swallow, the stroke victim’s family, friends and anybody close to him must learn to understand what is really happening within him. They must learn to adjust and get accustomed to this life changing event that has befallen their family member.

Dr. Janet Spradlin, a rehabilitation psychologist at St. Anthony Rehabilitation Center in Oklahoma City, said that changes in emotions seen in stroke survivors are typical after any type of stroke. She said that depression is a very common sickness in this type of scenarios. She added that any life-changing health challenges, most especially if it involves a loss of independence, usually results to the person falling into a state of hopelessness.

While it is true that the most common changes in emotion after a stroke is depression, there are other psychological changes that can be equally unbearable and upsetting to both the stroke survivor and his or her family and caregivers.

Changes in Personality


One major change in personality that may occur after one has endured a stroke is depression. It is caused by the biochemical alterations that happen in the brain which was caused by the stroke. Dr. Robert Robinson, a psychiatrist at the University of Iowa and a researcher on post-stroke depression said that depression may be caused by the injurious effects of the stroke on the brain. He added that the stroke victim may not be able to feel positive emotions which may lead to depression. It can also be surmised that the depression that the stroke victim exhibits is caused by the impairments which he or she may have acquired after the stroke incident.

Dr. Mark Huang, a professor of rehabilitation at the Rehabilitation Institute of Chicago said that a number of survivors who exhibit depression often lose the will to perform well in rehab. They are uninspired in therapy which is an important aspect of treatment. Dr. Huang added that these stroke patients are often discouraged and feel a sense of hopelessness. He pointed out that these people feel fatigued, are sleeping poorly and do not eat well.

Stroke victims undergoing depression should undergo treatment if they are not performing well during rehab. Dr. Huang added that the depression also affect their cognitive skills. He added that if the depression is not countered, they will have a hard time concentrating in rehabilitation. It also affects the stroke survivor’s attention to detail. He emphasized that if the stroke victim undergoes treatment for depression, their thinking skills will greatly improve. He underscored the need for the rehab team to be always on the lookout for signs of depression. He pointed out that two of the most important things that the healthcare team must be on the lookout for are mood and participation.

A number of stroke victims experience apathy where they seem to be unmindful and do not seem to care about his or her immediate surroundings. They are uninterested with their environment. Also, they seem to be indifferent and are generally content with doing nothing.


Dr. Spradlin said that most of the time, people are not aware that a stroke survivor may already be exhibiting apathy. She adds that people think that the stroke victim is already depressed because he or she is content with just sitting and staring at the wall the whole day. When asked for advice, she says that the best response is to get the stroke victim active and to start moving. She also proposes that immediate family members and caregivers could give the stroke patient choices of what to do. They could also suggest places where the stroke patient may go. She emphasizes that the family members and caregivers must make it clear that the goal is to get out of bed and do something and to not just lie in bed all day.


Another significant personality change that can be experienced by a stroke victim is impulsiveness. Stroke survivors with this personality change should be seen as victims of their own emotions. They should not be deemed as being very demanding. Dr. Spradlin said that stroke victims with this type of personality change are not capable of thinking ahead. She announced that stroke victims with this type of altered personality often move too quickly. She added that people with frontal lobe strokes or right-sided strokes are usually the ones exhibiting this type of personality change.

Are these Changes Permanent

One important question to ponder is “Are these changes in personality permanent?” Stroke victims as well as their own families and their caregivers can be distressed from all of these changes. One good thing to know is that these alterations in moods are not always permanent. Dr. Spradlin declared that it depends on what personality change the stroke victim is exhibiting. She adds that sometimes these changes can start to mellow down.

It is recommended that a stroke survivor consult a psychologist or psychiatrist as soon as depression is suspected, Dr. Huang said.

Dr. Robinson pointed out that a number of researches have shown that almost all stroke patients who undergo depression do not receive treatment for it. He added that doctors, family members and caregivers associate depression as an understandable response to the disabilities and impairments which occurs after the stroke incident.

People often do not believe that depression can be cured. But it is curable. It can be effectively treated when it is caused by biochemical changes in the brain as a result of the stroke. It is also curable if it was a psychological reaction to the stroke. Dr. Robinson asserts that it is very important for family members and caregivers to make sure that survivors do not simply explain away their depression and deny they need treatment just because it is “understandable.”

When depression is treated early, the stroke victim can experience improvements in their behavior. It also improves their physical recovery and also helps their cognitive and intellectual recovery.

What you could do with difficult stroke behaviors

Some stroke survivors can make life very difficult for the people around them. They act in such a way that their family and caregivers may think that they are acting out and making life miserable for everybody. What most people do not know is that the stroke victim may be exhibiting depression, anxiety and anger. And the worst part of it all is that the stroke victim may not know how to express his or her emotions. The stroke survivor often lashes out at the people around him or her. He or she may do it verbally, physically or both.

Difficult behaviors may also arise from personality changes the stroke victim may undergo. A number of caregivers and family members state that stroke patients are sometimes negative, impatient and are easily upset. They may also display childlike behaviors like lashing out verbally or sometimes may even get violent.

Adapting and embracing the changes in the stroke victim’s emotions, personality and behavior is easier said than done. It may even be more difficult than caring for his physical disabilities. The personality changes the stroke survivor exhibits may leave one wondering, if he or she is the same person one has known prior to the stroke incident. And most often than not, family members also feel disappointed. One can also enroll in a support group where one can vent out anxiety and fear. And learning that one is not alone in facing this situation can lighten up the burden.

Impulsiveness and inappropriate behavior may be hard to control but it is not impossible. Behavioral interventions can help stroke families adapt to the personality changes. By giving consistent verbal and visual cuing and making constant reminders, one can greatly aid stroke patients who have poor impulse control to mellow down.

Here are a few tips that family members and caregivers can do when they are facing such difficult situations:

  • Understand that it is not about you. The stroke survivor one is caring is angry about his predicament and not on his or her immediate caregiver. Also because of the stroke incident, the stroke victim may have lost some of his or her ability to control their emotions. Although it may be very difficult to even fathom, caregivers and family members should try keep their own emotions under control.  And if necessary, a timeout can be called for tempers to cool down.
  • Be positive and supportive – but firm. Although it will be very difficult, family members and caregivers should try to be positive and supportive for the sake of the stroke victim. They may also opt to say positive rather than negative statements. A good example could be “I can see that you’re very angry right now, but it’s not okay for you to yell at me like that. What do you think would help us both feel better?”
  • Making use of distraction and relaxation techniques. One of the best ways to confront difficult behaviors is to try and distract the stroke victim using relaxing activities. These may include watching a favorite TV show or listening to relaxing music. When both of you have calmed down, you may talk about his inappropriate behavior.   
  • Positive reinforcement is the way to go. Using a point system may help family members and caregivers in teaching stroke survivor how to behave properly. An example is assigning points when the stroke victim says he is upset instead of crying or screaming at his caregiver. The points he or she may have earned can be added up for a future reward. The rewards can either be a movie date or any activity that the stroke victim and his or her caregiver both enjoy doing. A sticker chart can also be used so that the stroke patient can view how he or she has progressed. This type of approach (sticker chart) can be deemed as childlike but a lot of stroke survivors have responded well to this method.
  • Minimize distraction and stimulation. A stroke victim may have a hard time focusing on getting dressing while the TV is turned on. This in turn may lead to his frustration and he may start again to behave inappropriately. Minimizing background noise can help him finish tasks which have been assigned to him.
  • Looking for a support group where one can share his or her feelings. Sometimes, a little social interaction can lead to numerous benefits. Talking to people who have the same very same experiences can be tremendously helpful. It also allows caregivers to connect with other caregivers.
  • Caregivers should always protect themselves. If the stroke victim starts to become violent, the one must take measures to prevent the stroke survivor from injuring himself and the caregiver. Family members may need to consult their doctor or the healthcare team about the abusive behavior. Enrolling the stroke patient in a nursing facility may also be considered.

Stroke Association
Caring: You’re there for them. We’re here for you.


  • MY caregivers seem not to relize how difficut it has been for me or is for me at times-they just push me verbally. sometimes i think they are just trying to totally change who i actually am. i dont usually if ever get upset with them-the anger or sence of failure is always pointed at myself.

  • Helene says:

    Dear Karen,

    We understand how it would feel like for you.

    Caregivers are there not to only assist you in your daily living. It is also to help you recover. Whenever they push you verbally, take it as a positive encouragement. Failing is part of things and we know it is frustrating. You have to try. Things will get better if you keep on following proper exercise, diet, and mind.

  • Lei says:

    Our family member is a retired physician who refuses to get treatment for her depression. She is verbally abusive (even before the stroke). Presently, her behavior is hurting my children, my marriage, and myself. It’s has been a very difficult situation for all of us. I know she feels pain, but all her anger and sadness is effecting us.

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