Depression Can Complicate a Brain Injury
Traumatic Brain Injury and depression are frequently seen together. One study from 2004 found that about one third of patients with a TBI also experienced major depressive disorder during the first year following the TBI. Other statistics put that number higher, around half of all people with a TBI. Compare this to rates of depression in the general population, which was 6.7% in 2015 according to the National Institute of Mental Health. Why is this number so high, and what can be done about it?
The symptoms of depression
First, let’s talk about what depression is and what it is not. In medicine, depression has a specific meaning. The word is not a synonym for feeling down or being upset about something. Depression refers to an ongoing mental state characterized by apathy, hopelessness, and loss of interest. People with depression may exhibit the following symptoms:
- Change in sleeping habits (especially excessive sleep)
- Change in eating habits (eating more or less than usual)
- Weight gain or weight loss
- Withdrawing from others
- Low energy
- Feeling worthless
- Feeling guilty
- Thoughts of suicide
Depression is a clinical condition, and is not something that someone can “snap out of.” Recognizing the signs in yourself and others, particularly if TBI is also a complicating factor, is crucial for a healthy recovery.
The reasons for comorbidity of TBI and depression
Why do people who experienced a traumatic brain injury more likely to develop depression? Seth Fischer, a fourth-year medical student at UC Davis who experienced a concussion in his second year, gives us a clue in the interview I recently did with him. Among his symptoms, including headaches, body aches, and light sensitivity, he mentioned depression, and made an interesting point about it: Was he experiencing depression because his brain was injured, or in reaction to the injury, or because of his chronic pain?
For someone who has been through a traumatic experience that has since affected their brain health, and their life as a whole, depression may be caused by a number of things.
Physical changes in the brain. While the physical mechanisms of depression are still not entirely understood, there could be a variety of reasons depression emerges in people with a TBI at a higher rate. For example, people who have experienced any kind of trauma, including abuse as a child, are more likely to experience depression, partially due, perhaps, to excessive stress hormones or surges in other brain chemicals, and the changes that creates in the brain.
Chronic pain in the body. After a TBI, many people suffer chronic pain, such as recurring headaches, back pain, and neck pain, arising from the accident that brought on the brain injury. Chronic pain and depression are known to be strongly correlated, with estimates as high as 22% and 46% of people with chronic pain diagnosed with depression.
Changes in social and professional life. People who have sustained a TBI often must take time off for some time after the injury before returning to their normal work and social activities. Some have cognitive, physical, or emotional symptoms that interfere with achieving their goals and may feel the need to “put life on hold” until they’re all better. This sudden and drastic change in routine, role, and responsibility can bring on depression.
History of mental health issues. It’s not surprising that the study referenced above found a higher rate of depression in people post-TBI who had a history of mood and anxiety disorders.
What to do about depression with TBI
Whenever depression is diagnosed, whether it’s diagnosed along with TBI or not, the first step should be to seek professional help. That may mean talking with your primary care physician about seeking help from a psychiatrist or psychologist who specializes in working with people who have had brain injuries. A treatment plan may include a combination of medication, lifestyle changes, and counseling or therapy.
In my discussion with Seth, he also talked about the isolation he felt. Speaking with other people in the same situation can be very helpful, whether that’s through a formal support group or just casual conversation in the clinic waiting room. Knowing you’re not alone is powerful.
Depression is something to watch out for after a TBI, and the good news is that it is treatable and that people do recover from it. Figuring out the causes, and getting the right support, will help you do just that.
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