Pennsylvania Senator John Fetterman made headlines earlier this year when he checked himself into the hospital for the treatment of clinical depression. The mental health struggles happened months after the then Senate candidate suffered a stroke. He recently returned to his job in the Senate, and told Americans 

“I want everyone to know that depression is treatable, and treatment works,” Fetterman said in a statement after his release.

Senator Fetterman isn’t alone. The American Stroke Association says depression is a common side effect of a stroke, sometimes caused by biological changes in the brain. The American Stroke Association (ASA) says more than one-third of post-stroke patients deal with depression. 

Yet, post-stroke depression is widely underdiagnosed and untreated. “It is important for patients and their loved ones to know of the risk of post-stroke depression and recognize its symptoms,” said Elizabeth Kera, Ph.D, Director of Psychology and Neuropsychology at the Neuroscience Institute at Hackensack University Medical Center and Assistant Professor of Neurology at the Hackensack Meridian School of Medicine. “Symptoms to look out for include persistent sad or empty feelings, significant fatigue, lack of motivation, social withdrawal, problems concentrating and sleep disturbances.”

Certain risk factors put stroke patients at a greater risk for post-stroke depression including a previous history of depression, the stroke’s severity, whether it left physical disabilities or cognitive impairments and a lack of family support.  

“In addition to organic causes of post stroke depression, there is certainly the potential for depression with the changes in life circumstances that often come with suffering a stroke including mobility issues, inability to work and the financial strain associated with it,” said Monique Tremaine, Ph.D, director of Neuropsychology at JFK Rehabilitation Institute. “Depression can also come with the different ways a post-stroke patient processes memories, speech and their ability to pay attention.”   

Patients who suffer a stroke on the left side of their brain often have their language processing, like Senator Fetterman, and speech impacted. This inhibits their ability to express their emotions, potentially leading to depression.  A patient who suffers a stroke on the right hemisphere of their brain often becomes isolated because they have a difficult time interpreting their own emotions and the emotions of others. Patients who suffered a right side stroke have difficulty understanding non-verbal communication and understanding nuances like sarcasm.  “With so many factors at play, individuals who experience cognitive changes as well as depression often have to adjust to a new sense of self, which can be quite difficult,” says Dr. Kera.

Depression can make stroke recovery harder as the patients may not feel motivated to work on their recovery.   “It is very important to know the signs of depression and to monitor for them post-stroke so that treatment can begin,” said Yolonda Pickett, M. D., Director of behavioral health for Hackensack University Medical Center.  “Depression can worsen a patient's prognosis and their ability to recover after a stroke, so it is very important to begin treatment for depression as soon as it is recognized."

Treatment for post-stroke depression can include but is not limited to the use of antidepressants, psychotherapy sessions or group stroke support group sessions.

Additionally, a recent study found the relationship works in reverse as well, people with depression are more at risk of having a stroke. People who had symptoms of depression had a 46% greater chance of suffering a stroke than those who had no such symptoms, according to a study led by a Ph.D student at the University of Galway in Ireland, published recently in the journal Neurology. The more symptoms of depression participants reported, the higher their risk of stroke, the researchers reported. For example, those who reported five or more symptoms of depression had a 54% higher risk of stroke than those with no symptoms, researchers said. This can also be tied to Sen. Fetterman’s story as he had previously suffered from depression, before having a stroke, but his Senate office said it became severe in February 2023, months after suffering a stroke.

“The reasons behind this associations is likely multifaceted and complicated, but contributing factors may include certain medications for depression can alter a patient’s blood pressure, and in some cases an association between depression and risk factors such as poor diet, lack of exercise, and alcohol use all of which can increase a person’s stroke risk,” Dr. Tremaine said.

As the nation marks both mental health awareness month and stroke awareness month this May, Hackensack Meridian neurologists and neuropsychologists can address the trending topic of the connection between stroke and depression, and what patients and their families can do to mitigate their risks for both stroke and depression.