Pennsylvania Senator John Fetterman, who survived a serious stroke the previous year, recently checked himself into Walter Reed National Military Medical Center for treatment of clinical depression. While his medical team had ruled out a second stroke or seizure after he reported feeling lightheaded, they recommended inpatient care for depression, which had reportedly become more severe in recent weeks. Though it has not been confirmed that his depression was directly related to the stroke, his situation highlights a common but often overlooked complication: post-stroke depression.

Understanding the Risk of Depression After Stroke

Post-stroke depression is a frequent complication among stroke survivors. It can be caused by several factors, including changes in daily function, emotional response to disability, genetic predisposition, and a history of depression. Coping with the physical and cognitive impacts of a stroke can make the recovery process emotionally overwhelming.

Individuals with a prior history of depression are more likely to experience it again, and the risk increases with each episode. A stroke adds an additional layer of vulnerability. Younger stroke survivors, in particular, may be up to three times more likely to develop depression or anxiety afterward, possibly due to the disruption of critical life milestones like education, parenting, or career development.

Biological changes in the brain may also contribute to depression. For instance, strokes affecting areas that regulate mood—such as the left frontal lobe—can increase the risk of developing depressive symptoms. Stroke-related changes in brain chemistry, particularly a reduction in dopamine levels, may also contribute to mood swings and emotional instability. Inflammation caused by stroke may further influence brain function by triggering immune responses that affect mood.

Symptoms of Depression

Depression goes beyond feeling sad. After a stroke, symptoms may include:

  • Persistent low mood

  • Irritability or apathy

  • Fatigue and low energy

  • Difficulty sleeping

  • Changes in appetite

To be diagnosed with clinical depression, at least two of these symptoms must last for a minimum of two weeks and significantly interfere with daily functioning at home, work, or in social settings.

How Common Is It?

About one-third of stroke survivors will experience depression, but some studies suggest the actual number could be much higher—possibly up to 80%. Depression may be underdiagnosed because many of its symptoms, such as changes in sleep, appetite, and focus, overlap with other stroke-related issues.

Most people who develop post-stroke depression do so within the first year of recovery, particularly around the three-month mark when they leave the hospital and begin adjusting to new limitations. However, depression can also arise months or even years later, depending on the individual.

Preventing or Managing Depression After Stroke

Prevention strategies for post-stroke depression are being studied more actively in recent years. Adopting healthy habits—such as eating well, avoiding alcohol misuse, staying physically active, and maintaining social connections—can reduce the risk of depression. However, lifestyle changes alone may not prevent all cases.

There is growing evidence that antidepressant medications, such as SSRIs like escitalopram, can reduce the risk of post-stroke depression and support functional recovery. Nonetheless, medication is just one component of a broader care plan.

The American Heart Association recommends routine depression screening for all stroke survivors, but screening rates remain low. Early detection through simple mental health questionnaires can help identify those at risk and lead to timely intervention by a mental health professional. Early treatment can improve recovery outcomes and reduce the severity and duration of depressive symptoms.

If left untreated, depression can severely impact a survivor’s ability to recover, leading to greater disability, social isolation, and lower quality of life. Treatment for post-stroke depression often mirrors that of typical depression, involving a combination of antidepressants, psychotherapy, and physical rehabilitation. Anti-inflammatory medications may help in some cases due to the role inflammation plays in post-stroke mood changes. Transcranial magnetic stimulation, which uses magnetic fields to stimulate brain activity, has also shown promise—especially for individuals with severe or treatment-resistant depression.

Conclusion

Depression is a common and treatable condition among stroke survivors. Although often overlooked, recognizing and managing post-stroke depression is vital to recovery. With early screening and appropriate treatment—including medication, therapy, and support—people affected by post-stroke depression can experience significant improvements in mood, function, and quality of life.