A stroke is sudden and shocking and affects every part of your life. Most people who've had a stroke will experience some kind of emotional change afterwards.
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Why do I feel different?
A stroke is sudden and shocking. It can affect every part of your life. It’s a lot to deal with, so it’s likely to have an effect on your emotional wellbeing.
Everyone’s experience of stroke is unique, but for many people it feels like they’ve lost the life they had before. Feelings of shock, denial, anger, grief and guilt are normal when you’re faced with such a devastating change. Dealing with them can be hard, and everyone does it in their own way.
Not only are you going through all these emotions yourself, but the people around you might be too. Often people don’t want to admit how they’re feeling and put on a brave face. So the people around you may not realise what you’re going through.
Others may assume that everything is fine, which can make it hard to tell them if it’s not. Communication problems may mean that you can’t explain how you’re feeling, even if you want to.
All of this can be hard to cope with. But if you don’t acknowledge the way you’re feeling and find things that can help you deal with it, these emotions can become overwhelming and lead to problems. Emotional problems can also affect your recovery, if you aren’t feeling motivated to take part in therapies, for instance.
Sometimes the damage that a stroke does to your brain can make you feel differently as well. Different parts of your brain control all aspects of your body and mind, including senses and emotions. If the part of your brain that controls your emotions is damaged, then this can affect how you feel.
Grief and loss after a stroke
A stroke can come with feelings of loss and grief. It’s a major life event, and for many people it leads to sudden changes at home, at work and in relationships. A stroke survivor might feel shock, anger and sadness at the changes and losses in their life.
Even a mild stroke can affect someone’s sense of themselves. And many people tell us that a stroke can make you lose a lot of confidence.
Going through feelings of grief takes time, and it’s different for everyone. Some people will be relatively unaffected, and others will struggle to manage the emotional impact.
There is no way of knowing how long it will last. Some difficult feelings don’t always go away by themselves. But by talking about it and seeking help you can often make a difference in how you feel. If feelings of sadness and anxiety are becoming overwhelming, let your stroke nurse or GP know.
It’s very common to feel anxious after a stroke. Around one-quarter of people who have a stroke will experience anxiety within the first five years.
Many worries are natural after a stroke. For example, you may worry that you’re going to have another stroke or be frightened about getting around on your own. You may also be worried about money or your family.
These fears should get better over time. If you’re becoming anxious about a wide range of things, or if you feel anxious for no obvious reason, then you should speak to someone about it. Getting support and treatment for anxiety can help you focus on things like rehabilitation, eating well and staying active. Feeling more relaxed will help you with your recovery, so don’t be afraid to seek help if you need it.
Signs of anxiety
We all experience slightly different things when we’re anxious, but you’re likely to notice some of the following:
A sense of dread.
Feeling on edge.
A racing heartbeat.
Trembling or shaking.
Feeling sick or ‘butterflies’ in your stomach.
It may not always be clear what you’re anxious about, which can make these feelings worse. Severe anxiety can be overwhelming. It can make you feel powerless or out of control. Living with anxiety can lead to sleeping problems, tiredness and muscle tension. You might feel more irritable, and avoid activities.
Other people can’t always tell what you are going through, so it can help to share your feelings with someone you trust.
“If I had a penny for the amount of times people say ‘you don’t look like you’ve had a stroke.’ On the plus side, it must mean I look well, but the downside is people don’t have a clue what I’m going through daily.” John-Lee
A panic attack is a sudden build-up of anxiety symptoms. It can feel overwhelming, and people having a panic attack might believe they are going to pass out or even die.
Feeling faint or light-headed.
Sweating or shaking.
Struggling to breathe.
A sense of fear.
It isn’t always possible to tell if someone is having a panic attack or if it’s something physical such as a heart attack or stroke. If you suddenly have new symptoms or you spot them in someone else, call 999.
Frequent panic attacks may be diagnosed as a panic disorder. It can affect your life if you live with a sense of fear, or start avoiding situations due to worry about having an attack.
Getting help with anxiety and panic disorder
Help is available. Treatments such as cognitive behavioural therapy (CBT) and medication are shown to help.
You can also learn self-help techniques such as breathing exercises and mindfulness. Like many emotional difficulties, having a healthy diet, dealing with sleep problems and being physically active can all help you manage your anxiety.
One of the emotions that nearly all stroke survivors have to deal with is frustration. So many things change after a stroke, and so quickly, that it can be hard to accept.
You may feel frustrated about:
Not being able to do what you used to do.
Having to rely on other people.
Everything taking longer than it used to.
Not being able to work or do other things.
Not being able to go out.
Not being able to express how you’re feeling.
Not being able to find the right word.
Feeling tired and having no energy.
Feeling frustrated is natural, and you’re going to feel this way from time to time. Everyone deals with frustration in their own way. For some people, it can lead to being more irritable or angry. It can make you more likely to get annoyed about things, or lose your temper.
You may get angry more often after you’ve had a stroke. It can be linked to many things, including your feelings of grief, loss and frustration about your stroke. It can also be linked with changes in the brain making it hard to control your emotions.
Some people feel they get angry for no reason, or get angry about things that didn’t bother them before. They might find it hard to control their temper. This can affect someone’s wellbeing and recovery. It can also be difficult for the people around them.
If you and the people around you feel that anger is affecting your life, it’s a good idea to talk about it or seek help.
What can I do about feeling frustrated or angry?
1. Let it out
If you’re becoming frustrated or angry you need to find positive ways to release the tension you’re feeling. That way you can focus your energy on more positive things, like getting better. Doing something physical, like going for a brisk walk or some other kind of exercise, can help you let off steam. Relaxation techniques can also help you to release tension and calm down.
2. Listen to others
Talk to your friends and family to work out what ‘triggers’ your anger (is it when you’re tired or bored for example?) and what you can do to avoid it. Agree on a prompt that they can use to let you know that you’re becoming angry or aggressive. It can be as simple as a word or a gesture, just something that will prompt you to take a step back and calm down.
Read our information and advice about behaviour changes and aggression after stroke, or call our Helpline for a printed copy.
Feeling low or depressed
It’s very common to feel sadness about stroke and the changes to your life. You might also feel low, which can include feeling sad or angry, like you can’t cope, and not enjoying things like you usually do.
A low mood can happen to anyone from time to time. But if you feel this way for a long period, and it’s affecting your ability to enjoy life, it could be a sign of depression.
Depression is common after a stroke, and we know that at least one-third of stroke survivors will have some form of depression within the first year. But you may not have it straight away. It can appear at any point, perhaps months or even years down the line.
It can also return over and over again. So it’s important to know what to look out for and how to get help and support if you need it.
Signs of depression
Depression affects people in different ways, but these are some of the more common signs that could last for some time:
Feeling sad or down in the dumps.
Feeling worthless, helpless or guilty.
Feeling hopeless or desperate.
Feeling anxious or worrying a lot.
Losing interest in things you used to enjoy.
Lacking energy or motivation.
Not going out or avoiding other people.
Finding it difficult to concentrate or make decisions.
Having problems sleeping or sleeping too much.
Losing your appetite or eating too much.
Losing interest in sex.
How to get help with low mood and depression
Feeling low or depressed can creep up on you, and it’s not always easy to know when you need to seek help. Depression can be mild, moderate or severe. Severe depression is a very serious condition, and it can sometimes lead to a mental health emergency. So it’s important to take your feelings seriously, and talk to someone if you feel something’s not right.
Feeling in despair or suicidal
Sometimes difficult feelings can lead to self-harming or thinking you can’t go on living.
Signs of suicidal feelings
It’s different for everyone, but some common signs of suicidal feelings include:
Hopelessness and despair.
Feeling there is no point in living.
Being overwhelmed by negative thoughts.
Thinking about death all the time.
Thinking you are not needed, and other people would be better off without you.
Feeling that your pain will never end.
Being cut off from your own body and feelings.
It’s important to remember that suicidal feelings will go away. How long they last varies between individuals, but the sooner you tell someone how you’re feeling, the sooner you can get help.
If you are feeling this way now, it’s a mental health emergency.
What to do about a mental health emergency
If you feel like harming yourself, or ending your own life, you should do one of these things:
1. Call 999.
2. Go to your nearest hospital accident and emergency department.
3. Contact your GP urgently and tell them what’s happening. They can refer you to a crisis team.
4. Visit the NHS mental health services page to find the number for your local 24-hour mental health helpline.
Difficulty controlling your emotions (emotionalism)
A stroke can affect your ability to control your mood and emotions. This is called emotionalism, sometimes known as ‘emotional lability’. It can mean that your mood changes very quickly and you are more emotional than you used to be.
You may find that you cry or laugh more and this can become extreme, such as laughing at something inappropriate. Or it can happen for no reason at all. Some people start to swear, when they didn’t do so before their stroke.
Emotionalism is most common in the early stages of stroke, when about one-fifth of people experience it. It can be upsetting, especially if you weren’t an emotional person before your stroke. Some people say they feel embarrassed, so they stop going out or try to avoid social situations.
If you’re more emotional it can be a sign of depression, but it can happen on its own too.
Signs of emotionalism
We’re all different and, by nature, some people are more emotional than others. So signs of emotionalism depend entirely on what’s normal for you. But these are some common signs:
Finding yourself crying or laughing for no reason.
Expressing your emotions more intensely than you actually feel them.
Feeling like you have no control over your emotions and that even the smallest thing can set you off.
Having emotions that seem out of place or come and go very quickly.
What can I do about emotionalism?
1. Give it time
Emotionalism does get better over time. Many people find that it improves or disappears altogether within the first six months. Even if your problems last longer than this, there are treatments and techniques that can help, so make sure you speak to your GP about it.
2. Be open about it
If you tell new people about your emotionalism when you first meet them, then you’ll be less embarrassed if you do become emotional in front of them. People feel awkward if they don’t know what to do, so they’ll appreciate it if you tell them how to help you.
You may prefer people to ignore it and just carry on as normal, or you may find a hug comforting when you get emotional. Lots of people have problems with emotionalism after a stroke, so talking to other stroke survivors can help as well.
3. Tell people when it’s real
You may have to tell people when you’re genuinely upset, so that they don’t mistake it for emotionalism. You’re still entitled to comfort and support, so don’t be afraid to ask for it.
4. Distract yourself
Some people say this helps them when they feel themselves starting to get emotional. So get up and go to another room or ask if you can change the topic of conversation or the TV channel. If you’re out with other people, ask someone else to distract you, or recite some words in your head – whatever works best for you.
Mania and euphoria
Mania is when your mood is extreme. It can be extremely high or extremely low and may swing between the two. Your energy and enthusiasm will change with your mood, so if it’s high you’ll seem hyperactive, you may talk very quickly, have lots of ideas and you may have difficulty sleeping. Mania isn’t a common effect of stroke, but it does affect some people.
Are there treatments that can help?
When emotions are overwhelming it can be easy to think that things will never get better, but they do.
And remember, you’re not on your own. There are lots of people who are there to help you cope with the way you’re feeling. You don’t have to do it alone.
Lots of treatments and therapies can help with your emotions after a stroke. Depending on the problems you’re having, your stroke nurse or GP may be able to refer you to someone who specialises in mental health, such as a psychologist or a counsellor.
Many people find that talking about the way they’re feeling helps them to be able to understand and deal with it. There are different types of talking therapies available, and your GP may be able to refer you. Medication can often help as well.
Talking therapies give you time and space to talk about your problems and explore difficult feelings with a trained therapist – this could be a counsellor, psychotherapist, psychologist or a psychiatrist. This can help you deal with specific problems or develop ways of coping with your thoughts and feelings.
Therapists can work with you one-to-one or jointly with your partner or other family members. Group therapy sessions are another option.
Cognitive behavioural therapy
One type of talking therapy that many people find helpful is cognitive behavioural therapy (CBT). This can help with many of the emotions people experience after a stroke and is recommended as a treatment for depression and anxiety.
CBT focuses on your thinking and behaviour and how they are connected. Negative thoughts can stop you from doing things, which in turn, can make you feel worse. CBT can help you break this cycle and improve the way you feel. It usually needs a number of sessions, over the course of several weeks.
To help you maintain your progress you can try reading books on CBT, which can guide you through exercises and techniques. There are also interactive computer and online programmes that you can try. Your GP or therapist may be able to recommend some suitable ones to you. Although most of these resources won’t have been developed specifically for people who have had a stroke, they’re still likely to have lots of information that can help you.
Talking therapy and counselling services through the NHS vary from area to area. In England, you can self refer (ask to use a service). Visit the NHS self-referral page to sign up, or ask your GP to refer you.
Your stroke team may have its own clinical psychologist or access to specialist services. Speak to your stroke nurse or therapist to ask for help.
Choosing private therapy
You can choose private talking therapy services if you want a choice of therapist or want more therapy than the NHS can usually offer. We’ve listed some websites later in this guide that you can use to look up what’s in your area, or you can contact our Stroke Helpline.
Typical private talking therapy prices can range between £40 and £80 for one session, so this isn’t an option for everyone. If you do decide to pay for private therapy, we suggest finding a trained therapist who has experience of working with people who have had a stroke. Read our information about using private therapy.
Medications can be very helpful for some emotional changes and depression. There are different types of antidepressant, which alter the chemicals in your brain and lift your mood. This can help to treat depression and sometimes anxiety. Medication can often help with emotionalism (difficulty controlling your emotions) as well.
Antidepressants don’t cure emotional problems, but they can help with the symptoms and make life feel easier. They don’t work for everyone and are usually best for people with more severe problems. They can also have side effects.
There are many different types of medication available, and it can take a bit of time to find the right one at the right dose. They can also take a little while to start working, and if you wish to come off them you need to get help from the GP on how to stop gradually. So if it’s something you decide to try, you’ll need to persevere and work with your GP to find what works best for you.
What can I do about the way I feel?
1. Get some help
There’s a lot to cope with when you’ve had a stroke, so don’t be afraid to ask for some help. If you’re worried about the way you’re feeling, or you think you may be experiencing some of the problems we’ve described, then you need to speak to your GP, stroke nurse or therapist about it. They will be able to tell you about the support that’s available. Emotional problems are often missed by doctors and sometimes it can be difficult to get them taken seriously. However, you need to trust that you know yourself better than they do, so don’t be afraid to keep asking to get the support you need. If you don’t think you’re getting the right support from your GP or stroke team, then contact our Stroke Helpline.
2. Talk to someone about it
Talking about the way you’re feeling with someone who understands can really help. You may want to do this with a counsellor or therapist or it could be a family member or friend – whoever you feel most comfortable talking to. Many people also find support groups helpful, because you can talk about your problems with people who are going through the same thing. Stroke clubs and groups are a good way to meet other stroke survivors and get advice and support, but there are all sorts of groups out there.
“I wasn’t able to cope with it all on my own. Talking to my doctor and getting some counselling was the best thing I ever did.”
3. Stay informed
A stroke can make you feel low or anxious. But talking to the right people and finding answers to your questions will help you feel more in control. For many people, the fear of having another stroke can cause a lot of stress. So talk to your GP about things you can do to reduce your risk of it happening again. There are many things you can do to help you stay healthy, such as being active, having a healthy diet, and sleeping well. All those things also contribute to your emotional well-being.
If you’re worried about not being able to go back to work, speak to your employer or Jobcentre Plus about how you can be helped back into the workplace. If you have an occupational therapist, they could offer some advice and support. If money worries are on your mind, find out what financial support you can get. Read our information about financial help and benefits after a stroke, or call our Helpline for some ideas about the help available to you.
Communication problems can make it difficult to ask questions, but your speech and language therapist can help you talk to other members of your stroke team, if that will help you get the information you need.
4. Take it easy on yourself
Many people find that they have to learn what’s ‘normal’ for them again after they’ve had a stroke. This means listening to both your body and your brain, and not expecting yourself to do too much, at least not to begin with. There’s no need to be embarrassed about the way you’re feeling – there’s a lot to cope with. Be open about the problems you’re having. If you’re not sure how to talk to other people about it, remember that they might not realise what’s going on with you and they might find it helpful to know. Tell them if there is anything they can do to help.
“Accept that you’re going to have bad days and don’t push yourself too hard when you do. Take each day as it comes.”
5. Find new goals
Many people feel that they lose their sense of purpose after a stroke. This can really affect your confidence and make you feel down. That’s why it’s important to stay connected to the people and things in your life as much as possible. This can be hard, as you may not be able to do everything that you did before. But there will be things that you can do, so focus on these. Set yourself small goals to work towards, one step at a time.
Keep track of the progress you make, as it can be easy to forget, especially if things don’t happen as quickly as you’d like. It can be particularly hard if you worked or were involved in lots of things before your stroke. But you need to remember that there are still opportunities out there, you may just need to find other ways to use your skills and talents. Many people find that things like volunteering, taking part in research, or finding new interests help them to feel useful again after their stroke.
6. Be as active as you can
When you’re active your body releases chemicals into your brain that make you feel happier. Because of this, exercise has been proven to help with a number of emotional problems. It doesn’t have to be running or swimming, even a short walk or a bit of gardening can have a positive effect. If you can’t get up and about, practising physiotherapy exercises will get you active, or try some chair-based exercises. Yoga and tai-chi involve elements of mindfulness and relaxation, as they encourage you to focus on your body and breathing. So why not give them a go? Even if you have physical problems, many of the movements can be adapted. Speak to a local instructor or contact your local stroke group and ask about suitable classes.
Read our information about staying active after a stroke.
7. Try relaxation
Relaxation can help you cope when your emotions start to feel overwhelming. Research has shown that relaxation can be particularly helpful in treating anxiety after stroke. There are techniques you can learn to help you relax. These usually focus on breathing or releasing tension from your muscles. Many people find that mindfulness (a type of meditation) or other forms of meditation help them too. These are techniques that encourage you to pay more attention to the present moment – to your own thoughts and feelings as well as your body and the world around you. This can be especially helpful when you’re feeling overwhelmed. There are plenty of books, DVDs and websites that can teach you about relaxation and meditation. Although most of them won’t have been designed for people who have had a stroke, there’s still likely to be a lot that you can get from them and many stroke survivors do find them helpful. There are also many courses on relaxation or mindfulness. Try contacting your local college or library to see if they can tell you about any in your area. Courses are provided by the NHS in some areas. So ask your GP if there’s anything available where you live.
“Rest your mind as well as your body.”
8. Express your feelings
Writing things down can help you deal with negative thoughts and feelings. Many people find that keeping a journal helps them – it doesn’t have to be written, you could keep a video journal instead. Things like art, music, photography or poetry can give you a way of expressing your feelings as well. Communication problems can make it very hard to express how you’re feeling. But that shouldn’t stop you from getting the emotional support you need. So if you’re struggling with your emotions and would like to talk to someone, tell your speech and language therapist and ask what support is available for you.
Look after yourself
Write down the compliments that people give you and the achievements you make, so that you can go back and remind yourself of them when you’re feeling down. And think about your appearance – looking good makes us all feel a little better. So treat yourself to a haircut or a manicure. If you can’t get to a salon yourself, find someone who can come out to your house.
Eat well and avoid caffeine and alcohol
If you’re not eating much or you’re comforting yourself by eating junk food all the time, then it’s going to make you feel tired and run down. So try to eat regular meals with lots of fruit, vegetables and fish. Reduce alcohol and caffeine, as they can alter your mood and affect your sleep. Read our information about healthy eating, and find out more about alcohol and stroke.
Tips for family and friends
It can be difficult to know how to help someone with their emotions after a stroke. So here are some suggestions.
1. Talk to each other
Sometimes it’s hard for people to talk about their feelings, even with someone close. So let them know that you’re willing to listen and ask them what you can do to help. Sometimes there won’t be anything you can do, which can be tough. But just being there for them and encouraging them to seek help if they need to, is often all it takes.
2. Spend some time with them
Coping with the effects of stroke can make people feel very lonely. So simply spending some time with your friend or family member can really help. You may not have time to visit them as often as you’d like, but even a short phone call will show them that you’re thinking about them.
3. Support their independence
It’s normal to want to do as much as possible for someone, but it will be better for your friend or family member if you help them to do things on their own, rather than do all of it for them. So encourage them to give things a go. Although they may not think they’ll be able to, more often than not they’ll be pleasantly surprised.
4. Help them stay active
Being active helps to lift our mood, so encourage your friend or family member to do whatever they can. It will help if you do it together. Even if they can’t get up and about, there may be chair-based exercises they can do and they’re likely to have exercises to practise if they’re having therapy.
5. Be patient
It takes time for things to improve, so you’ll need to be patient. This isn’t always easy, especially when you’re coming to terms with everything that’s happened as well. So make sure you’re looking after yourself and you have someone to talk to.
Read our information for carers for ideas about ways of getting help and support for caring, or call our Helpline.