Changes in emotion are often expected after a stroke, which occurs when the blood supply to part of your brain is blocked or diminished. Since strokes affect the brain, and the brain controls our behavior and reactions, it’s common for stroke survivors to experience more negative emotions than they did before. Irritability, confusion, anger, and depression are likely, the American Stroke Association says. Forgetfulness is common, as well.

However, research also suggests that negative emotions may have a hand in increasing stroke risk. A 2021 global INTERSTROKE study published in the European Heart Journal linked anger and other upsetting emotions—like sadness, depression, or anxiety—to an approximately 30 percent increased risk of suffering a stroke one hour later. And this study isn’t the first to connect strong, negative emotions to stroke risk.

A 2004 statement from the American Academy of Neurology (AAN) describes a survey of 200 people who were hospitalized with an ischemic stroke (which happens when blood clots restrict blood flow to the brain) or a transient ischemic attack (essentially a mini stroke). Approximately 30 percent of those surveyed reported anger, fear, irritability, nervousness, or a shock that caused them to suddenly change their body position in the two hours before their stroke. Another 2021 study published in Scientific African suggests a link between emotions like anger and fear and increased stroke risk factors like diabetes and hypertension. Although emotions and mental health were once thought completely separate from our physical health, there’s an increasing amount of evidence that the two are connected.

“Emotions can cause physiological changes in our bodies,” says Matthew Socco, PhD, an expert in stroke at the Cleveland Clinic. “When a person is under stress, it causes their body to increase sympathetic nervous system activity. Think ‘flight or fight’ response,” he says. When our sympathetic nervous system gets activated, it affects blood pressure, heart rate and rhythm, and many other physiological responses that have been linked to increased stroke risk, Dr. Socco says.

I don’t want people to panic every time they have an argument with someone. Your brain is actually quite flexible, so an occasional, momentary increase in blood pressure … is nothing to be alarmed about. ” — Elizabeth Marsh, MD

Some scientific evidence indicates that holding emotions in can lead to increased stroke risk and heart problems, particularly for women, Dr. Socco says. “Having a healthy outlet for difficult emotions can be a very effective tool for reducing the health risks associated with bottling it all up!” he says. Many mental health experts refer to bottling up negative emotions as “toxic positivity,” which can be quite damaging to your mental (and, it turns out, physical) health.

Scientists are learning more about how strong the mind-body connection is, Dr. Socco says. The exact mechanisms and impact of emotional health on stroke risk are still unknown,  but “if there is a chance a person can reduce their risk and improve their health as it relates to stroke or any other medical condition, it deserves to be explored more fully,” Dr. Socco says.

Of course, as human beings with a wide range of emotions, it’s impossible to avoid ever feeling angry, sad, or afraid. Elisabeth Marsh, MD, a neurologist at Johns Hopkins Medicine, worries that news from these studies will cause unnecessary worry. “I don’t want people to panic every time they have an argument with someone,” she says. Your brain is actually quite flexible, so an occasional, momentary increase in blood pressure or other sympathetic nervous system activity is nothing to be alarmed about. It’s not that your blood pressure goes up, and then you have a stroke. “The brain is adjustable,” Dr. Marsh says. “The vessels adapt.”

Evidence points toward chronic anger, anxiety, stress, and depression causing more problems. Although your brain’s blood vessels are very malleable, chronic stress that leads to chronic high blood pressure can put too much strain on them and cause damage, Dr. Marsh says. Chronic stress or depression also tends to lead to unhealthy habits like smoking, overeating, and avoiding exercise, which also impact your stroke risk.

While mental health seems to be a vital part of managing stroke risk, it’s also important, as always, to eat well, exercise, and keep an eye on your blood pressure. “Some of the best ways to prevent stroke are to maintain a healthy lifestyle, treat high blood pressure, and not to smoke, but our research also shows other events such as an episode of anger or upset or a period of heavy physical exertion independently increase the short-term risk.” Martin O’Donnell,  PhD, a professor of neurovascular medicine and co-author of the INTERSTROKE study, said in a statement.

Interestingly, the aforementioned healthy behaviors will likely also help with mental and emotional health. Studies have suggested that exercise can combat depression, chronic stress, and anxiety. Running, walking, boxing, swimming, or otherwise moving your body could be one of the healthy emotional outlets, Dr. Socco says. Aerobic exercises like these also increase blood flow to your brain, helping to prevent clots that lead to blockage. Anger and upset are bound to happen, but it seems a healthy body and mind are what’s really needed for your best chances at avoiding a stroke.

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