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Emotional Disorders from Stroke

Few medical events are as traumatic as stroke, and it can take an emotional toll on you as a survivor, and on your family, even as you recover.

While you will experience a variety of strong emotions in the wake of stroke, some emotional problems may need to be dealt with for you to fully recover. These include depression, anxiety, and uncontrollable emotions.

Uncontrollable Emotions

During stroke recovery, survivors may also find themselves laughing or crying at inappropriate times. This may be a result of a condition known as pseudobulbar affect (PBA), which is a common medical condition among stroke survivors. It is clinically distinct from depression.

This inability to control emotional responses may be confusing and frustrating for stroke survivors, and may compound feelings of social isolation, fear, and shame.

Neurologic disorders such as PBA typically involve involuntary emotional displays such as uncontrolled crying or laughing, and can occur in the wake of stroke.

In some cases, these episodes may even be mood-inappropriate: for example, you might laugh uncontrollably, even if you are angry.

Sometimes referred to as involuntary emotional expression disorder (IEED), it can be characterized by an exaggerated and uncontrolled display of emotion.

Signs & Symptoms

Some people who have experienced PBA report them coming on almost like a seizure, with an outburst of emotion lasting anywhere from seconds to several minutes. And PBA may happen several times a day, sometimes severely.

Causes of PBA

PBA is commonly associated with stroke, and while the precise triggers are not completely understood, it is thought to be caused by a disruption in the brain’s neural network that generates and regulates emotional output and motor control.

Anywhere from one-quarter to one-half of stroke survivors report experiencing PBA, with prevalence rates higher in patients who are older or who have had prior strokes.

There are also indications that stroke survivors with depression experience a deeper depression if they have PBA.


Grief in the wake of stroke is a common and even healthy reaction for a stroke survivor, but when it becomes depression, it is important for you to get treatment.

In some cases, depression can be caused by damage to the brain from the stroke, itself.

Some symptoms of depression may include:

  • Feelings of emptiness
  • Chronic fatigue
  • Sleep disorders
  • Inability to concentrate or make decisions
  • Feelings of helplessness
  • Sudden irritability
  • Suicidal thoughts

Severe Anxiety

Anxiety is another common feeling among stroke survivors, and, if it is not controlled, can adversely affect recovery, rehabilitation, your relationships and quality of life.

Signs of severe anxiety may include:

  • Continuous worry, fear, irritability, and restlessness
  • Feelings of panic and shortness of breath
  • Rapid heartbeat
  • Shaking
  • Nausea
  • Poor concentration
  • Muscle tension

Treatment of Emotional Disorders from Stroke

It is important for stroke survivors and their caregivers to recognize PBA when they see it, as it is possible for PBA to be misinterpreted as depression, in the case of a survivor crying uncontrollably.

The traditional treatment of stroke-related emotional disorders involves the use of antidepressants such as:

  • Fluoxetine
  • Citalopram
  • Amitriptyline

While there is no current FDA-approved treatment for conditions such as PBA, antidepressants may offer some help. Some combination drug therapies have also shown promise in the treatment of PBA.

Your doctor will be able to offer a more targeted approach to treatment.

The following techniques may help you cope with PBA:

  • Warning people that you cannot always control your emotions, and that they may not always be reflective of how you are really feeling
  • Distracting yourself as you feel an outburst coming on may help
  • Changing your body position—if your “crying posture” is a particular position, if you feel yourself crying uncontrollably, try to change your posture
  • Breathing in and out slowly to regain control
  • Relaxing your muscles when you feel yourself tensing up when crying
Last UpdateApril 30, 2012