Poststroke Anxiety: The Other Poststroke Mood Disorder

Post-stroke anxiety (PSA) affects around 20% to 25% 1 of individuals and can negatively impact stroke rehabilitation 2 and quality of life.3 Phobic disorders, generalized anxiety, panic disorder, and posttraumatic stress disorder are among the most commonly diagnosed anxiety conditions after stroke.4 A variety of factors can increase risk for PSA including comorbid depression, lack of social support, stroke severity, socioeconomic hardship, and impaired cognitive function.5 While awareness of PSA has increased in recent years, research into the identification and treatment of PSA continues to receive less attention than poststroke depressive disorders.6 With similar prevalence rates between PSA and post-stroke depression, increased understanding of diagnosis and treatment of PSA disorders is needed.Addressing this disparity, Lomachinsky Torres, et al 7 investigated 126,050 acute ischemic stroke patients aged 65 and older.Utilizing Medicare claims from the United States they examined new benzodiazepine (BZD) prescriptions for suspected anxiety, insomnia, and agitation following discharge over an eight-and-a-half-year period.As noted by the authors, BZD use in older adults is of significant concern due to increased risk of dementia, falls, stroke severity, polypharmacy, and the potential for dependency.Although a number of guidelines have been published concerning BZD use among older adults, 8 national rates of post-stroke BZD prescriptions remain relatively unknown.Study findings indicate that within 90 days of hospital discharge, 4.9% of the study sample was started on a BZD.The majority (76%) had first prescription days' supply greater than seven days and more than half (55%) had a first fill supply between 15 to 30 days.Higher rates of BZD initiation were seen among women and patients of Hispanic ethnicity.While a modest decrease in BZD prescriptions were found from 2013 to 2021, a pattern of concerning BZD prescriptions covering two weeks or longer were observed.These findings highlight a concerning pattern of possible BZD overprescription in vulnerable adults following ischemic stroke.In addition to the number of risks regarding BZD use already noted, prolonged use of BZD for certain anxiety disorders (i.e., posttraumatic stress disorder) 9,10 and insomnia are not recommended.11,12 With these factors in mind, accurate diagnosis and treatment options for PSA in older patients are