Each year approximately 305,000 people in the United States have a mild stroke.
1
A mild stroke occurs when a doctor identifies a lesion in a person’s brain using a brain scan, but the person is still able to do everyday activities, such as getting dressed.2
After a mild stroke (even months or years later), you may experience mental health conditions due to brain damage caused by the stroke or the stress of being in the hospital. Your mental health is just as important as your physical health. If you are experiencing mental health concerns, it is important that you get the help you need. This handout is designed to help people with mild stroke and their care partners identify and get appropriate care for mental health conditions following a mild stroke.
How can I recognize mental health concerns?
People with mental health conditions report feeling not like themselves. If you are experiencing mental health problems, you might feel sad, unmotivated, tired, or anxious. While everyone feels some of these emotions from time to time, you should seek help if you experience signs or symptoms of a mental health condition over several weeks, if your mental health impacts your ability to do your regular activities, or if you notice changes in your personality. Table 1 describes the signs and symptoms of different mental health conditions that commonly affect people after mild stroke.
Table 1Mental health conditions associated with mild stroke
| Mental Health Condition | Percentage of People With Mild Stroke With This Condition: | Signs or Symptoms May Include: |
|---|---|---|
| Depression 3 , 4 | 30%-40% |
|
| Anxiety 5 , 6 | 20%-50% |
|
| Post-traumatic stress disorder 7 , 8 , 9 | 5%-30% |
|
| Fatigue 10 | 20%-40% |
|
| Sleep disorder 11 | 50%-70% |
|
Is it possible to have more than 1 mental health condition?
Yes, it is possible to have more than 1 mental health condition because these conditions are often interrelated. For example, if you are not sleeping well, you may feel fatigued and depressed. Also, the experience of having a stroke can be stressful and can worsen existing mental health conditions.
Toughing it out vs getting help
It is important to recognize that mental health concerns are common among stroke survivors and nothing to be ashamed of. Having a stroke is a both major life event and a disruption in brain activity. Having mental health concerns is not a sign of weakness or cause of shame. It just means you need a little extra help. Never be ashamed to get the help and support you need. Talk to your health care provider know if you are experiencing mental health concerns.
What will my health care provider do?
To diagnose a mental health condition, your health care provider may ask you some questions or have you fill out a survey to determine if you have a mental health condition. Sometimes, they may refer you to another health care professional like a psychologist, psychiatrist, neurologist, or counselor. Learn more about mental health conditions and take online screenings using resources like http://www.mentalhealthamerica.net/mental-health-screening-tools.
What is the treatment for mental health conditions?
The good news is that treatment can help people with mental health conditions feel better. There are a variety of treatment options available to you depending on your symptoms. Talk to your health care professional about what treatments might be right for you. Treatments range from exercise or attending a support group to intensive talk therapy with a mental health professional or medication changes.
Table 2 describes some of the different treatments your help care team might recommend to address your mental health concerns. It is important to note that mental health treatments can take several weeks to start working. Once started, mental health treatment should not be stopped without talking to the health care team.
Table 2Mental health treatments for people with mild stroke
| What is the Name of the Treatment? | Who Benefits From the Treatment? | What Would the Treatment Look Like for You? |
|---|---|---|
| Self-Care | ||
| Exercise 12 | People with all mental health conditions | Exercise promotes good mental health. You would engage in a range of physical activity such as
|
| Pacing for fatigue 13 | People with fatigue | Pacing is a strategy developed in collaboration with a health care professional. You would learn the amount of energy you have in a typical day and then plan your day accordingly. |
| Socialize with friends and family and continue regular routines | People with anxiety or depression | You would try to maintain your routines, like getting out of bed and getting dressed at the same time every day. You would also work to remain engaged in your previous social activities, such as going to religious services or civics groups. |
| Support groups for people with mild stroke and their family members 14 , 15 | People with mental health conditions and family members | You and your family members would share your stroke recovery story to a group of peers. You would hear your peers’ stories and learn what strategies they have found most helpful. |
| Talk Therapy | ||
| Acceptance & commitment therapy 16 | People with anxiety or depression | You would talk with a psychologist or counselor to recognize your reactions to life events. Then you would select actions that are consistent with your goals and values. |
| Behavioral activation 17 | People with depression | You would talk with a psychologist or counselor to identify activities that you used to enjoy. Then you would try to re-engage and become more active. |
| Cognitive-behavioral therapy 18 | People with anxiety, depression, sleep issues, or fatigue | You would talk with a psychologist or counselor to identify negative thoughts. Then you would finding new positive ways to think and develop new coping strategies. |
| Medications | ||
| Medications for stroke and side effects of medications 19 | People with all mental health conditions | People with mild stroke often get medications to manage their health and reduce the risk of having another stroke. In some people, their existing medications can cause side effects (like fatigue and depression). A doctor and pharmacist would evaluate your current medications and may adjust medications to improve mental health. |
| Medications for mental health 20 | People with all mental health conditions | Doctor may prescribe a new medication specifically for the treatment of mental health issues. |
What should I do in a mental health crisis?
A metal health crisis is when a person feels like hurting themselves or someone else. If you are having a mental health crisis, you should get help immediately. You can talk to a friend or family member or a trusted health care professional. If you want to talk to someone anonymously, you can contact the Crisis Hotline 1-800-273-TALK (8255) or text 741741. In case of emergency, you should call 911.
Resources
Tabled
1
| Resource | Description | Contact |
|---|---|---|
| If you want more information… | ||
| American Stroke Association | Learn more about stroke and find stroke-based supports. | http://www.strokeassociation.org |
| National Alliance on Mental Illness | Learn more about mental health conditions, treatment options, local support services, legal issues, and support for family members. | Text NAMI to 741741 1-800-950-NAMI (6264) https://www.nami.org/ |
| Mental Health America | Take a screening test for mental health conditions and use the database to find local mental health resources. | http://www.mentalhealthamerica.net |
| If you want to talk to someone… | ||
| National Stroke Association | People with mild stroke, caregivers, and family members can speak with call-center volunteers. | 1-800-STROKES (787-6537), menu option 3 http://www.stroke.org/stroke-resources/stroke-help-line |
| Stroke Family Warmline | Persons who have questions about stroke or who just want to talk to another stroke survivor or family member can contact the Stroke Family Warmline. | 1-888-4-STROKE (7653) |
| If you are having a crisis… | ||
| National Suicide Prevention Hotline | Persons who feel like hurting themselves can reach out to the National Suicide Prevention Hotline at any time of day or night. | 1-800-273-TALK (8255) Text 741741 https://suicidepreventionlifeline.org/ |
Authorship
This page was developed through the Health Wellness Taskforce of the American Congress of Rehabilitation Medicine Stroke Interdisciplinary Special Interest Group by Alexandra L. Terrill, PhD, Jaclyn K. Schwartz, PhD, OTR/L (e-mail address: [email protected] ), and Samir Belagaje, MD.
Disclaimer
This information is not meant to replace the advice of a medical professional and should not be interpreted as a clinical practice guideline. This Information/Education Page may be reproduced for noncommercial use for health care professionals and other service providers to share with their patients or clients. Any other reproduction is subject to approval by the publisher.
Acknowledgment
Dr Terrill received NIH NCMRR award number R03HD091432 (PI: Terrill).
References
- Changing face of stroke: implications for occupational therapy practice.Am J Occup Ther. 2009; 63: 621-625
- What is mild stroke?.Arch Phys Med Rehabil. 2017; 98: 2347-2349
- Depression after minor stroke: prevalence and predictors.J Psychosom Res. 2015; 79: 143-147
- Depression after minor stroke: prevalence and predictors.Eur J Neurol. 2012; 19: 517-521
- Post-stroke depression and post-stroke anxiety: prevalence and predictors.Int Psychogeriatr. 2015; 27: 1805-1812
- Predictors of depression and anxiety in community dwelling stroke survivors: a cohort study.Disabil Rehabil. 2014; 36: 1975-1982
- Chronic posttraumatic stress symptoms after nonsevere stroke.Neurology. 2006; 66: 513-516
- Prevalence of PTSD in survivors of stroke and transient ischemic attack: a meta-analytic review.PLoS One. 2013; 8e66435
- Frequency and predictors of post-traumatic stress disorder after stroke: a pilot study.J Neurol Sci. 2013; 327: 35-40
- Fatigue, psychological and cognitive impairment following transient ischaemic attack and minor stroke: a systematic review.Eur J Neurol. 2014; 21: 1258-1267
- The relationship between sleep disturbance and functional status in mild stroke patients.Ann Rehabil Med. 2015; 39: 545
- Exercise and mental health: many reasons to move.Neuropsychobiology. 2009; 59: 191-198
- Cognitive and graded activity training can alleviate persistent fatigue after stroke.Stroke. 2012; 43: 1046-1051
- Participants’ experiences of hospital-based peer support groups for stroke patients and carers.Disabil Rehabil. 2012; 34: 347-354
- Coping with the challenges of recovery from stroke.J Health Psychol. 2008; 13: 1136-1146
- A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems.Psychother Psychosom. 2015; 84: 30-36
- Behavioral activation treatments for depression in adults: a meta-analysis and review.Clin Psychol Sci Pract. 2009; 16: 383-411
- Cognitive behavioral psychotherapy for depression following stroke: a randomized controlled trial.Stroke. 2003; 34: 111-115
- National Stroke Association. Medications.(Available at:) (Accessed June 13, 2018)
- Mental health medications.(Available at:) (Accessed June 13, 2018)
Article Info
Publication History
Published online: February 09, 2019
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine All rights reserved.
