Overview of Anxiety After Stroke
At a glance
Anxiety is common after a stroke, affecting about a quarter of stroke patients and nearly a third of those with a transient ischemic attack (TIA). It can hinder rehabilitation and prevent patients from returning to normal activities. Pharmacologic, psychological, complementary, or alternative therapies are currently available to treat post-stroke anxiety. In addition, a better understanding of the predictors of stroke anxiety may improve the management of these disorders.
As a leading provider of stroke research services, Ace Therapeutics is committed to helping clients investigate the pathology of anxiety after stroke and developing potential therapeutics.
Risk Factors of Anxiety After Stroke
Here are some of the primary risk factors associated with anxiety after a stroke:
Preexisting Depression or Anxiety
Individuals with a history of depression or anxiety disorders before the stroke are at a higher risk of experiencing anxiety afterward. The psychological impact of a stroke can exacerbate these conditions.
Cognitive Impairment
Cognitive decline following a stroke can lead to difficulties in coping with the new realities of life post-stroke, increasing the likelihood of developing anxiety.
Fatigue
Chronic fatigue, which is common after stroke, can affect physical and mental health, potentially contributing to feelings of anxiety as individuals struggle to engage in daily activities.
Age
Older adults may be at greater risk of post-stroke anxiety. Age can affect coping mechanisms and resilience, making it more challenging to adapt to the changes following a stroke.
Sex
Research indicates that females tend to have a higher prevalence of post-stroke anxiety compared to males, possibly due to biological, psychological, or social factors.
Lesion Location
The specific area of the brain affected by the stroke can influence emotional and cognitive processing. For instance, lesions in areas associated with emotional regulation may predispose individuals to anxiety.
Sleep Disturbance
Sleep problems, including insomnia and poor sleep quality, are common after a stroke and can contribute to anxiety symptoms, as adequate rest is crucial for mental health.
Fig. 1 Modelling processes and outcomes of treating anxiety after stroke. (Chun, et al., 2018)
Symptoms of Anxiety After Stroke
Post-stroke anxiety is a psychological condition that can occur in individuals after experiencing a stroke. It is characterized by intense feelings of anxiousness or worry that are often difficult to control. To qualify for a diagnosis of post-stroke anxiety, an individual must exhibit a persistent pattern of anxiety along with at least three additional symptoms from the following list:
- Restlessness
- Decreased energy
- Poor concentration
- Irritation
- Nervous tension
- Insomnia
Current Interventions for Anxiety After Stroke
Researchers are interested in pharmacologic, psychological, or alternative therapies that are primarily aimed at treating post-stroke anxiety. However, no specific guidelines have been developed for treating anxiety in stroke.
Current Drug Research in Anxiety After Stroke
Various drug classes target different neurotransmitter systems to treat anxiety after stroke.
| Examples | Mechanism | |
|---|---|---|
| Selective Serotonin Reuptake Inhibitors (SSRIs) | Fluoxetine, Sertraline, Escitalopram, Paroxetine, Citalopram | Inhibit serotonin reuptake by presynaptic terminals, increasing serotonin availability in the brain. |
| Tricyclic Antidepressants (TCAs) | Imipramine | Act as serotonin and norepinephrine reuptake inhibitors, enhancing neurotransmission. |
| Benzodiazepines | Diazepam, Alprazolam | Enhance the effect of GABA, reducing physical anxiety symptoms like muscle tension and insomnia. |
| Z-Drugs | Zopiclone, Zolpidem, Zaleplon | Similar to benzodiazepines but with a shorter half-life. |
Psychological Therapies for Anxiety After Stroke
Various forms of psychological therapies are available for treating anxiety after stroke.
Behavior Therapy
Behavior therapy, grounded in learning theory, focuses on cultivating adaptive behaviors while reducing maladaptive ones. Its primary goal is to address anxiety through targeted techniques that encourage positive behavioral patterns and eliminate negative or undesired behaviors.
Cognitive Therapy
Cognitive therapy is rooted in the cognitive model, which posits that a person's emotions and behaviors are shaped by their interpretation of events.
Cognitive-behavioral Therapy (CBT)
CBT incorporates elements from both cognitive and behavioral therapies with the goal of changing a person's thoughts, beliefs, attitudes, expectations, and how a person acts.
Complementary or Alternative Therapies for Anxiety After Stroke
Other therapies, such as exercise training and relaxation therapy, have also been employed in treating anxiety. Exercise training may serve as a stress buffer by promoting the release of monoamine neurotransmitters, while relaxation therapy helps individuals identify symptoms of anxiety and respond to them using techniques designed to reduce arousal.
- Chun, H. Y. Y., et al. (2018). Treating anxiety after stroke (TASK): the feasibility phase of a novel web-enabled randomised controlled trial. Pilot and feasibility studies, 4, 1-11.
