4 Common Mental Health Issues After A Brain Injury Or Stroke And How To Best Manage Them

When Mark and I met, he was a very serious individual and I was a little more on the sarcastic/funny side.  So we meshed well, balancing each other out.  After he had a brain bleed in 2015, he started to show a new personality.  I was not at all prepared.

Many individuals will find they have mental health changes after a brain injury or stroke.  Personalities change and often the individual and the people in their lives were not prepared for this, on top of having to deal with the after effects of the event itself.

If you have had a stroke or a brain injury or are caring for someone who has, read on.  Things you may be experiencing are normal and are treatable.


For those who have had a brain injury or stroke, anxiety can be caused by several different factors:

  • The ability to process things like light and sound can be altered
  • The fear of experiencing another event can linger
  • Initially sorting out things like work, finances, relationships can be overwhelming
  • Uncertainty about the prognosis and long-term effects it will have is frightening

Ways to decrease and manage your anxiety include knowing what situations may trigger anxiety.  Many individuals also find it helpful to find support from others who have or are currently going through the experience.  It may also be helpful to establish routines that will allow your days to be more predictable.

Here is a link to find a stroke support group near you:


Ignoring the feelings of anxiety generally backfires for most people, making it worse.  So if the above suggestions are not helpful and your anxiety is keeping you from having a good quality of life, speak with your healthcare provider about possible medication options.

Living with chronic anxiety is detrimental to your overall health and will hinder your recovery.


This is often a difficult one for people to identify and admit is a problem with their mental health. As a healthcare provider myself, I often hear people say “Yes, I feel sad most days.  I’m OK though.”

If you are feeling sad most days, you are not, in fact, OK.  While I certainly feel after a life-altering health event, you do have the right to feel down and sad, it should not be daily and if it is impacting your quality of life, it should be addressed sooner than later.

Depending upon the part of the brain that was impacted by your stroke or brain injury, there can be several physiological factors that are contributing to your depression.  Meaning it’s not just something you can “walk off.”  You may need medical intervention to help alleviate the symptoms.

Depression diagnosis can often include the following symptoms:

  • Feelings of worthlessness
  • No longer enjoying activities that were previously important to you
  • Difficulty concentrating
  • Loss of appetite
  • Difficulty sleeping or sleeping too much

Keep in mind that some of these symptoms are common after a stroke or brain injury.  However, if they persist and are keeping you from moving forward in your recovery and from enjoying your life, please speak to your healthcare provider as soon as possible.

If you don’t currently have a healthcare provider, there are free and low cost resources available.  Click this link for a free and not-for-profit online resource that may be of help:



Up to 70% of individuals who have experienced a brain injury or stroke may have residual insomnia.  Insomnia is defined as:

  • Difficulty falling asleep
  • Difficulty staying asleep
  • Waking too early
  • Feeling tired after waking
  • As well as increased depression and anxiety (It’s all tied together)

As a healthcare provider and prescriber, I’m not a big fan of sleep medications unless they are absolutely necessary because they tend to increase falls for certain populations of people.  They also often come with some pretty significant side effects and can interact with other medications.

So if we look at someone’s “sleep hygiene”, which is just a fancy way of talking about our evening habits, we can sometimes resolve sleep issues medication free.

The best way to try to naturally improve sleep after a stroke or brain injury…or actually for all of us, includes the following:

  • Going to bed and waking at the same time every day
  • Avoid any caffeine (this can include soft drinks, tea, coffee and chocolate) after 2pm
  • No electronics 1 hour before bed (this is a good time to read a book, newspaper, magazine)
  • Keep the bedroom cool and dark
  • Try to get some natural light during the day
  • Participate in some physical activity during the day (but not too close to bedtime)

There are many things we do in our modern world that throw off our natural biological clocks and sabotage our sleep.  Making some simple changes to our daily habits is often all we need to get better sleep.

If these don’t work, talk to your health care provider.  Getting sleep is essential for your overall health and well-being, so there are times medications are needed.

Pseudobulbar Affect

I’ve saved this one for last because this is the sucker punch I experienced with Mark after his stroke.

Like I mentioned earlier, Mark was very, very serious prior to his brain injury.  However, he now has a pseudobulbar affect and it’s a whole new ball game.

Pseudobulbar affect is involuntary bouts of anger, sadness or laughter.  It is not something the individual can control and it is often very pronounced when you are interacting with someone who has it.

One example is; if I am crying, let’s say about work,  Mark will respond with the loudest and most boisterous laughter you have ever heard!  Which initially made me feel so awful!  While it still makes me uncomfortable in certain settings (like when he bursts out laughing in church) I have come to understand this is not something he is capable of controlling.

If you have this experience or live with someone who does, it can be very challenging to be in a public setting or situation without feeling like everyone is staring and judging.


I have actually found that some family members carry around business sized cards that explain that their loved one has a brain injury or diagnoses that causes them to have these reactions in public.  This way those around them know why the person is responding that way, while still preserving the individual’s dignity.

Click this link to find these cards:


There are also medications for pseudobulbar affect and symptom management.  I would recommend speaking to your healthcare provider if you are feeling like the symptoms are interfering with your ability and opportunities to participate in things that will improve quality of life.

Social gatherings, church, shopping, family events are all important.

Symptoms can be managed and life can still be lived!  Remember, people are generally kind, understanding and more patient than our media would lead us to believe.

One thing I’ve learned through my discomfort with Mark’s boisterous laugh:  It makes me so uncomfortable, but everyone that he talks to thinks they are a comedian because of his laugh.  So they walk away feeling great about themselves and Mark has the opportunity for some positive socialization.

Please know that things will eventually settle and all of these new challenges will become more manageable.  It can be so overwhelming when you are dealing with new physical challenges after a brain injury or stroke, but to pile on mental health issues can just feel like too much.

Always know there is support and resources all around you, both locally and nationally.  With the internet, help, education and support can be just a click away.  Don’t wait until you’re barely keeping your head above water to ask for help.


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