Depression is a common complication following a stroke, affecting approximately 30 percent of survivors at some point during their recovery. This serious condition – known as post-stroke depression – can significantly hinder physical rehabilitation and diminish overall quality of life.
The development of PSD is multifaceted, involving both biological and psychological components. It can occur immediately after a stroke or develop months or even years later.
“A stroke is a huge, life-altering event – something that requires a lot of adjustment,” said Dr. Farah Fourcand, a neuroendovascualar surgeon and director of the Stroke Center at Cleveland Clinic Indian River Hospital.
“It’s not just emotional; it’s biological. Brain chemistry changes. Neurotransmitters like serotonin and dopamine, which influence mood and behavior, are disrupted. This can lead to symptoms similar to general depression, including feelings of hopelessness that interfere with daily functioning.
“Common symptoms of PSD include insomnia, low energy and loss of appetite – symptoms that can easily be attributed to the stroke itself, making depression difficult to recognize,” Dr. Fourcand continued. “It’s often very muddied. There are a lot of gray areas, and because of that, it’s under diagnosed. But it’s important to identify because it affects not just mental health but also mortality, recovery and long-term outcomes.”
Stroke survivors can face sudden lifestyle changes, disability and other losses that trigger feelings of frustration, isolation and grief – further elevating the risk of depression.
According to the American Heart Association, depression following a stroke is associated with a higher mortality rate, slower recovery, impaired cognitive function and reduced quality of life.
“Early identification of post-stroke depression is crucial,” said Dr. Fourcand. “The best window for physical, occupational and speech therapy is during the acute phase – when the brain is most responsive to neuroplasticity and healing. If someone is struggling with depression at that time, their ability to engage in therapy and benefit from it is greatly diminished.”
While depression can slow rehabilitation, making it harder for survivors to regain independence and function, diagnosing PSD can be tricky. Many stroke survivors don’t recognize their mood changes as depression.
“They often assume their symptoms are just a part of recovering from the stroke,” Dr. Fourcand said. “That’s why it’s essential to be open and honest with healthcare providers about emotional and mental changes during follow-up visits.”
Additional challenges arise when the stroke impacts the left frontal lobe, an area responsible for language. This can result in aphasia, which impairs speech and comprehension.
“Patients may understand everything but struggle to express themselves – or they might speak in jumbled, nonsensical sentences,” Dr. Fourcand explained. “This communication barrier makes diagnosing depression difficult, so we rely heavily on non-verbal cues.”
Another possible confounding factor is pseudobulbar affect (PBA), a condition marked by episodes of uncontrollable laughter or crying, often mistaken for depression. It typically occurs in people with certain neurological conditions or injuries that affect the way the brain controls emotions. Once diagnosed, PBA can be treated with medication.
Unfortunately, lingering stigma surrounding mental health can prevent stroke survivors from seeking help.
“Many people are uncomfortable discussing depression,” Dr. Fourcand said. “I’ve seen stroke survivors who were once the head of their household, now dependent on others. It’s a huge identity shift. They feel ashamed or try to downplay how they’re feeling. I try to reframe it as a medical issue – a brain chemistry change – so they can better accept the diagnosis and treatment.”
Fatigue only worsens the emotional burden. The brain takes time to heal, and survivors may feel like a burden, overwhelmed by sadness and hopelessness.
Because PSD is complex, individualized treatment plans are necessary. Antidepressants, particularly SSRIs (selective serotonin reuptake inhibitors), are commonly used and may not only lift mood but also enhance motor recovery.
“There’s evidence that SSRIs can help stroke survivors regain strength,” Dr. Fourcand said.
“Whether it’s because they’re more motivated to participate in therapy or because the medication directly supports brain pathways, the results are encouraging.”
Psychological interventions also play a critical role. Cognitive Behavioral Therapy (CBT), motivational interviewing, and psychosocial support have all shown promise. “CBT is especially effective,” said Dr. Fourcand. “It helps break the cycle – your thoughts influence your feelings, which influence your behavior, which reinforces those thoughts.”
Support groups can help by connecting survivors with others who understand their journey. These groups foster social connection, reduce isolation, and provide access to helpful resources. Cleveland Clinic partners with Encompass Acute Rehabilitation to offer local stroke support groups.
Once cleared by a physician, stroke survivors may also benefit from a structured exercise program. A minimum of four weeks of consistent physical activity can complement other treatments and significantly reduce depressive symptoms.
Post-stroke depression is more than an emotional response to major trauma – it’s a medical condition deeply tied to the brain’s healing process. Left unrecognized or untreated, it can derail physical recovery and prolong suffering. But with early intervention, a tailored treatment plan and a supportive care team, survivors can reclaim not only their strength but also their sense of hope. Acknowledging PSD as a real, treatable condition is the first step toward restoring both body and mind.
Dr. Farah Fourcand received her medical degree from Herbert Wertheim College of Medicine in Miami and completed a residency in neurology at Georgetown University Hospital in Washington, D.C. She completed fellowships in endovascular surgical neuroradiology; neurocritical care; and vascular neurology at Hackensack Meridian JFK University Medical Center in Edison, N.J. Her office is located in the Indian River Hospital Medical Office Building, 1155 35th Lane, Vero Beach. For an appointment call 772-563-4741.
