Anxiety and Depression  |  Supporting Persons with Disabilities  |  Supporting Seniors & Elderly

Stroke and Depression: What is the link?

BY DR KINJAL DOSHI

29 July 2020  |   5 min read

A stroke impacts each individual differently depending on the type and severity. Regardless, each individual who has had a stroke recognises that they cannot return to living their lives as they did before the stroke. For many, surviving a stroke means having to make changes to their lifestyle, which can be difficult. Some stroke survivors have to wrestle with the loss of physical mobility and cognitive ability, which translate into a loss in function, and as a result, independence. Thus, it is not uncommon for an individual who suffered a stroke to experience a sense of loss and grieve for their previous pre-stroke self. In addition, their difficulty adjusting to the “new normal,” can make them feel helpless. These feelings often manifest into anger at themselves and others, and eventually, into hopelessness and depression.

Recognise Symptoms

Recognizing symptoms and sharing them with your doctor can help treat depression and aid recovery. Symptoms of depression include feeling down, a loss of interest in activities that were previously enjoyed, changes in sleep patterns and appetite. While some stroke symptoms, such as lesser emotional expression or difficulty in communicating, may make it tough to identify depression, it is important for stroke survivors and their care partners to notice warning signs of sadness and share this with their doctors.

Managing Depression

1. Start with the basics. After a stroke, it is difficult to imagine being able to do things like before. However, a sense of routine enables stroke survivors to regain a sense of urgency over their lives, especially when there are changes to their lifestyles. Set a short-term achievable goal as simple as getting out of bed and taking a shower. It does not matter if they do not achieve anything else for that day. With that first step taken, slowly identify the next small step and add that to the next day’s activity. Care partners can offer encouragement by allowing the stroke survivor to perform such basic tasks as independently as possible.

Care partners can offer encouragement by allowing the stroke survivor to perform such basic tasks as independently as possible.

2. Contribute even in the smallest way. Perhaps, they are unable to do tasks they previously were proud of doing independently. Some stroke survivors may have given up their jobs or stopped activities that kept them occupied and made them feel useful. Identify tasks such as cleaning and cutting vegetables, doing the laundry, washing dishes, or minding the grandchildren, that the stroke survivor is still able to perform to help them focus and feel they are not a burden to others.

3. Talk to other stroke survivors and find purpose supporting them. Having a stroke may make an individual feel different from others and alone in their experience. Thus, being able to interact with other stroke survivors provides much needed social interactions as well as comfort that they are not alone in their circumstances. By becoming a befriender, themselves, it affords them a sense of purpose to be there for others.

4. Engage in a meaningful activity. This includes physical, social and leisure activities that are tailored to the individual’s needs and preferences. Identify at least one activity that they find meaningful to participate in regularly. They can choose an activity they previously enjoyed, which may need to be adapted to accommodate their current condition; for example, having a stroke survivor who used to enjoy swimming take a water aerobics class designed for individuals with physical limitations. Get them to identify activities that they found interesting but never had the opportunity to participate in such as art lessons with family and friends. In fact, even just getting outside to sit in the fresh air helps stroke survivors.

5. Learn to accept the new version of themselves. A lot of hopelessness stems from the understanding that things are never going to be the way it used to be. In fact, anger and depression are emotions experienced together with loss and grieving, and success is punctuated by acceptance. It helps to not compare them to their pre -stroke selves. Rather, it helps them to identify their strengths and abilities that they can adapt and build upon into a new version of themselves.

6. Seek professional help. It can be difficult to start anew after a stroke, and sometimes, stroke survivors and their care partners need assistance. Such assistance may include goal setting, identifying values and strengths, and even planning of activities. A counsellor or psychologist may be able to help provide such assistance as well as offer strategies such as mindfulness to manage stress. In addition to counselling, medication can support them until they recover emotionally from the stroke.

Additional Resources

The contributor is a Principal Psychologist at Singapore General Hospital.