The Complete Guide to Post Stroke Depression

The Complete Guide to Post Stroke Depression

More than 40% of stroke survivors deal with post stroke depression.

To help shed light on this crucially important topic, so that you can fuel your motivation to recover, we’re going to discuss:

  • Why post stroke depression is often neglected
  • What the 4 causes of post stroke depression are
  • How to start pulling yourself out of the dark

Since this is our complete guide, so it’s going to be long. (Reeeally long.) So prepare yourself, and maybe grab some coffee…

It’s Time to Shine a Light on Post Stroke Depression

We believe that post stroke depression is neglected because the most “critical” stroke deficits manifest on the outside, whereas depression manifests on the inside. Let us explain.

As an example, most stroke survivors suffer from mobility impairments after stroke that need to be addressed for safety and independence reasons. Without relearning how to swallow or move, a stroke survivor cannot live on their own; therefore, these stroke deficits are far more “dire” than the emotional effect of stroke.

We understand this argument, but this is where we would like to make a difference.

While the stroke deficits that impair independence are indeed dire, so is post stroke depression. Because if a stroke survivor is depressed, then they may not even have the motivation to pursue that independence.

It’s a vicious cycle. Most stroke survivors are depressed because of their lack of independence and mobility, and that depression causes them to avoid doing the rehab exercises necessary for more independence and mobility!

That’s why we believe in a mind-body approach to stroke rehabilitation.

Because if you can manage your emotions and get your mind in a better place, then you will absolutely see better results in your body because one motivates the other.

This concept is simple, but as you can imagine, it’s also fairly difficult to put into practice when you’re in the grips of post stroke depression.

But we have methods to help! First, let’s dig even deeper into the causes of post stroke depression.

The 4 Main Causes of Post Stroke Depression

Post stroke depression can be caused by many different factors that are unique to each individual. However, we have been able to boil everything down into 4 main causes:

1. Changes to the Brain

Stroke can directly cause depression due to changes in the brain. One example is emotional lability, which is characterized by intense mood swings due to damage in the emotion center of the brain.

But depression can be caused by many other changes to the brain, too. For instance, if stroke causes damage to the frontal lobes – which help regulate emotion, decision making, and judgement – then post stroke depression can occur.

2. Changes in Thought Patterns

To continue this example, a shift in judgement can cause a stroke survivor to move from thoughts like ‘this situation sucks but at least I’m okay’ to ‘this situation sucks and I will never get back to my old self.’ This shift in judgement can create a slippery slope that slides into depression.

3. Changes in Lifestyle and Abilities

Changes to lifestyle and ability after stroke are the most common causes of post stroke depression. Because when you cannot complete the tasks that you one completed with ease, it can become very frustrating. And if stroke deficits are severe, this frustration can spiral into depression.

4. Changes in the Way Others Treat You

Perhaps the most frustrating and hurtful thing about disability is the way that people treat you. Because we are in the industry, we have seen this with our very own eyes, and we understand why this can lead to depression.

Luckily, there are ways to treat all of the above causes of post stroke depression.

Let’s discuss each.

Treating Post Stroke Depression Due to Emotional Lability

As we mentioned, emotional lability is a stroke side effect that occurs when there is changes to the emotion center of the brain. The methods that stroke survivors can use to bounce back from this vary greatly.

Some stroke survivors are lucky enough to have ‘spontaneous recovery,’ where the condition essentially fixes itself over time. In these cases, only time will tell and practicing patience could be the best solution.

However, other survivors who experience intense depression due to brain damage may want to seek medical attention – especially if depression is getting in the way of recovery. There is nothing wrong or shameful about taking meditation for post stroke depression.

Should You Seek or Avoid Anti-Depressants?

This is a hot, controversial topic, and we aren’t picking sides. Here’s what you need to know about choosing to go with or without medication.

When to seek medication:

Those who should seek medical attention for depression are those who are severely unmotivated to pursue recovery and/or have seriously or jokingly considered suicide.

Even if you think it’s just a joke, please talk with your doctor or a trusted counselor about suicidal thoughts. You can also call the suicide hotline at 1-800-273-8255 at any hour of the day.

We strongly recommend talking to a doctor, also, because if you are severely unmotivated about pursuing recovery, then anti-depressants can give you the boost you need to pursue independence.

Also, we encourage you to join our stroke support group on Facebook to gain the support you need during this difficult time.

Medication does NOT make you weak:

If you talk to your doctor and are prescribed anti-depressants, this does not mean you are weak. Stroke survivors are among the strongest individuals because stroke recovery takes an immense amount of hard work.

No one should judge their potential need to get help for something that affected their brain’s ability to be happy.

When to consider skipping medication:

Note: Please take the following advice at our own discretion and be sure to consult with your doctor first.

From what we have seen and heard, it may be a good idea to avoid medication if you were put on anti-depressants immediately from the start. This makes sense because you never really know if you need them or not because you haven’t tried being without them.

By experimenting, you will be able to see how you feel when you’re off your medication; and if you feel better, more power to you! And if you feel worse, then end the experiment. Most of all, be careful and consult with your doctor.

At the end of the day, the choice to take anti-depressants is totally up to you. There is no harm in talking with your doctor and exploring the.

And if you’re into alternative options, we have found that probiotics can actually help with some cases of depression due to the intimate connection between your gut and your brain.

Now, onto the next cause of post stroke depression.

Treating Post Stroke Depression Due to Thought Patterns

Our thought determine our emotions, including depression. If you have read our book Healing & Happiness After Stroke, you know exactly why this is.

If you haven’t read it yet, then just trust us on this one. Our thoughts are inextricably connected to our emotions.

This means that if you start to think negative thoughts, you will start to feel negative. This may seem like an extremely obvious concept, but it shows us exactly where we have the opportunity to turn things around.

Depression is no joke. And telling yourself to ‘just think happy thoughts’ is unrealistic for many. This is where neuroscience can come into play.

We talk about neuroplasticity a lot on the blog, and the basic premise is that your brain becomes better at what you repeatedly practice.

With that said, if you repeatedly practice better thoughts, you will start to feel better; because your thoughts and emotions are directly connected.

Exercise: Rewire Your Thought Patterns

This exercise will help you rewire your thought patterns – and we’re going to start slow.

Because you can’t dive in and start thinking drastically positive thoughts that you don’t believe yet. Otherwise you will start fueling a negative feedback loop where you’re saying one thing but thinking another, and you’ll get nowhere (this is also explored further in the book).

Instead, start small by writing in a gratitude journal every day.

Gratitude is an easily accessible emotion for anyone; and it feels a lot like positivity – only it’s much easier to generate when you’re coming from a state of depression.

To start a gratitude journal, all you need to do is write down at least 10 things that you’re grateful for every day – but the more the merrier!

By doing this, you are rewiring your brain to be more grateful, and this is a great stepping stone towards feeling happier, too.

Treating Post Stroke Depression Due to Lifestyle Changes

When stroke takes away your ability to live and behave like before, it can spiral into depression. When all the little things that you used to perform with ease – like cooking or driving – are suddenly taken away, it’s very natural to feel sad.

And that’s the biggest point we’d like to make: depression is normal. Do not confuse depression with believing that something is wrong with you.

The statistics say that 40% of stroke survivors experience depression, but we believe the percentage is actually much higher.

So please don’t think that there’s something wrong with you because you struggle with depression. Instead, think about how strong you are becoming because of this fight!

8 More Ways to Cope with Post Stroke Depression

To help cope with post stroke depression, strive for slow, steady progress. Because when you witness even the smallest improvements, it gives you hope and motivation that you can get back to life as it was before.

Human beings are incredibly motivated by progress, and doing something that will produce results (like stroke rehabilitation exercises at home) can help reduce depression.

Other ways to cope with post stroke depression are:

Being creative. Make a work of art – even if you don’t consider yourself an artist. We aren’t aiming for beauty, we are aiming for therapy.

Reading something inspirational. For many stroke survivors, reading inspirational material is absolutely essential. That’s why our motivational quotes post is so popular. Some great sources of inspiration are Tiny Buddha, Marc & Angel, and Zen Habits.

Starting and finish a task. If you have the mobility and ability to start and finish a task – even if it’s something as common as doing the dishes – it will lead to an immense feeling of satisfaction that can help lift your mood.

Getting outside! We don’t even need to explain why the great outdoors are amazing because you already know. So get out there. If you don’t have the mobility to go for a walk, then just sitting on your porch or on a park bench is enough to lift your mood.

Joining a support group. We have read comment after comment from stroke survivors in our support group expression how much they love and need the support they get from other stroke survivors in the group. If you haven’t joined our group already, do it now!

Sleeeeping. Most survivors are startled by how much sleep they need after stroke, but rest assured that it’s normal! Your brain needs time to heal, so listen to your body. If you’re craving sleep – even if you just woke up from a nap an hour ago – then let yourself sleep.

Starting a passion project. When you are working on something you’re passionate about, you get lost in it. And if you’re feeling depressed, then getting lost in a passion project is just the thing you need.

A great example of a passion project is starting a blog! You could even start a blog about your recovery to help provide other stroke survivors with your advice and experience that you learned along this journey.

*Allowing yourself to feel your emotions. This concept is the most important – and thoroughly discussed in our book because the more you resist negative emotions, the stronger they become.

It’s only when you can softly lean into what you’re feeling and face your truth that life becomes better. And it’s even better if you can use these feelings as a source of fuel to motivate you to do those rehab exercises or go for a walk!

Treating Post Stroke Depression due to Shame

Previously we said that the fourth common cause of post stroke depression is changes in the ways others treat you. And this phenomenon is best described as shame.

Because when we feel inadequate, unlovable, and not enough, shame binds us into depression.

And the worst part is that it’s often invisible because when we feel shameful, we hide. We don’t want others to see us while we’re down because we’re afraid of their judgment.

But chances are, if you’re always on guard for judgement from others, you’re probably guilty of judging yourself.

So, instead of beating yourself up for feeling shameful, you can use it as a sign that shows you exactly where you could be loving yourself more.

Shame also ties in with low self-esteem, and both of these topics are covered in our Healing & Happiness book.

Why Did We Mention the Book so Many Freakin’ Times?

Sorry (not sorry), but we mentioned the book a lot because we wrote it just for you during difficult times like these.

Finding happiness is the central theme – that’s why it’s called Healing & Happiness After Stroke.

It doesn’t just gloss over post stroke depression, it digs straight into it.

The book addresses the 5 cornerstones of post stroke depression: limiting beliefs, poor thought patterns, broken identity, lack of motivation, and low self-esteem.

The entire book revolves around getting you out of post stroke depression.

And because we wrote it specifically for fans of our blog, we posted the first 3 chapters for free on our site.


This article was LONG because post stroke depression is a neglected topic. We discussed these 4 causes and solutions:

  1. Post stroke depression can be directly caused by brain injury, which is best treated with time and maybe medication.
  2. Depression caused by poor thought patterns can be corrected with repetitive practice of better thoughts. A gratitude journal can help with this.
  3. When changes to lifestyle and abilities has caused depression, it can be lessened in a plethora of ways including creative projects, getting outside, reading, sleeping, and joining a support group.
  4. Lastly, post stroke depression is perfectly normal, but talking about it isn’t. That’s why overcoming shame is one of the most important steps for overcoming post stroke depression.

All of these topics are discussed in our book Healing & Happiness After Stroke.