Experiencing depression after a stroke is common. Medical professionals may recommend managing symptoms with medications as well as psychotherapy and other non-pharmacological interventions.

“Poststroke depression” (PSD) is the term for depression that may develop after you’ve experienced a stroke.

According to the American Heart Association and the American Stroke Association, PSD affects up to one-third of people who have had a stroke or a transient ischemic attack (sometimes called a ministroke).

A 2024 research review suggests that PSD may affect up to 43.9% of older adults.

While the exact causes of PSD are not fully understood, experts believe biochemical changes and inflammation resulting from a stroke affect parts of the brain that are associated with mood regulation and thinking ability.

The results of a small 2023 study with 85 participants suggest that stroke may contribute to depression by changing the brain’s serotonin networks and affecting neuroplasticity (the brain’s ability to repair, adapt, and form new connections between neurons).

Environmental factors can also play a role in PSD. Recovering from a stroke can be stressful, and not everyone has access to support networks. Stroke can lead to major changes in your abilities and can put a significant strain on your everyday life.

PSD is not a formal medical diagnosis. Instead, experts consider it a subtype or presentation of depression that starts after a stroke.

The diagnostic criteria for poststroke depression are the same ones that the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) lists for major depressive disorder, which is also known as clinical depression.

According to the DSM-5-TR, a depression diagnosis requires that you experience most of the following symptoms for most of the day, every day, for at least 2 consecutive weeks:

  • low mood involving sadness, hopelessness, or a sense of emptiness
  • anhedonia (loss of interest in activities you used to enjoy)
  • persistent feelings of guilt or worthlessness
  • changes in sleep patterns
  • changes in appetite
  • fatigue, low energy, and decreased motivation
  • a tendency to move more quickly or more slowly than usual
  • trouble concentrating or making decisions
  • thoughts of death or suicide

At least one of the first two symptoms must be present for the diagnosis.

Depending on which areas of your brain are affected, a stroke may cause you to experience a variety of mental health symptoms.

According to a 2023 research review, depression, anxiety, and post-traumatic stress disorder (PTSD) are the three most common mental health conditions associated with stroke.

Other emotional and behavioral symptoms that are possible after a stroke include:

  • mood changes
  • severe irritability
  • severe apathy
  • low impulse control
  • pseudobulbar affect (mismatched feelings and expressions, such as laughing when sad)
  • anosognosia (a lack of awareness that you have a medical condition)
  • aphasia (an inability to produce or understand verbal communication)

Symptoms such as delirium (confusion and agitation) and psychosis (distorted perceptions, such as hearing or seeing things that are not there and holding false beliefs) are possible but rare.

Stroke affects each person differently, and some people recover from a stroke without experiencing significant mental health challenges.

No standardized treatment guidelines have been developed for PSD. Medical professionals treat it the same way as other manifestations of clinical depression.

Medications and psychotherapy are the first-line treatment approaches.

Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are common antidepressants used in PSD. A doctor may recommend alternative therapies depending on the chance of side effects and the person’s medical history and individual needs.

Psychotherapy, particularly cognitive behavioral therapy (CBT), is effective for managing some symptoms of PSD.

CBT focuses on helping you identify and restructure unhelpful ways of thinking and behaving that may be causing you distress. CBT also helps you develop coping skills for everyday challenges.

Treatment approaches such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation may work in some cases if other treatments have not been effective. These neuromodulation therapies use electrical or magnetic currents to stimulate brain cells in targeted areas of your brain.

In additional to traditional treatment approaches, a healthcare professional may suggest that you try one or more complementary practices such as yoga, meditation, mindfulness, or music therapy. These activities could help you manage stroke-related stress that may worsen depression.

Poststroke depression is a common experience, especially in older adults. Symptoms may include low mood, decreased energy, loss of interest in most activities, and changes in appetite and sleep patterns.

PSD may develop as a result of a combination of biochemical changes in your brain and environmental factors during stroke recovery, such as chronic stress. Treatment may involve medications as well as psychotherapy and other non-pharmacological interventions.