Traumatic Brain Injuries and Depression: What’s the Link?

Suffering from a traumatic brain injury can be a challenging experience to go through. The emotional trauma of recalling the event that led to the injury, such as a sports injury, car accident, or assault, along with the functional and mental difficulties surrounding the recovery period, can be emotionally taxing for anyone. Frustration, sadness, fear, and worry are all common emotions for those that have experienced a traumatic brain injury. 

While this type of emotional response after a traumatic event is to be expected, have shown that approximately half of people that experience a traumatic brain injury also experience clinical depression at some point during their recovery. This rate is much higher than the rate of individuals that suffer from depression in the general population, which ranges from 6%-12%. 

The commonality of clinical depression in individuals that suffer from traumatic brain injury raises the question: what is the link between traumatic brain injury and depression? 

What is a traumatic brain injury?

According to the Agency for Healthcare Research and Quality, a TBI occurs when an external force from an event such as a fall, sports injury, assault, motor vehicle accident, or explosive blast, injures the brain and causes a loss of consciousness or memory. These injuries can cause tissue damage, swelling, inflammation, and internal bleeding. The severity of these brain injuries vary greatly, depending on the type and force of the injury. 

American Trauma Society highlights that TBI leads to approximately 1.2 million emergency department visits each year, although the prevalence of TBI is thought to be much higher due to the fact that individuals that suffer only mild injury often forgo medical attention. Each year, anywhere from 80,000 to 90,000 people will suffer from long term disability due to a TBI. TBI is more common in men than women, and affects athletes, military personnel, the very young, and the very old at higher rates. 

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Traumatic brain injury and depression 

A traumatic brain injury (TBI) is any injury that affects how the brain works, and is commonly caused by a bump, blow, or jolt to the head, or by penetrative injury. Depending on the severity of the injury, it is possible for people to experience symptoms post-injury that last for a couple of days, or for as long as the rest of their lives. Most people are familiar with concussions, which are a type of TBI, and are common for athletes of all levels. 

In a study of adolescent athletes, researchers found that sports concussion was associated with a 3.3 fold increase in the risk for depression when compared to those athletes without a history of brain injury, as well as a 40% increased risk of developing a variety of other mental health disorders. These disorders include: 

• Anxiety
• Adjustment reactions
• Behavioral and substance use disorders
• Suicidal ideation
• Schizophrenia
• Disorders of psychological development 

Psychological impairment represents a serious issue for people recovering from a TBI, and major depressive disorder has been found to be one of the most common forms of impairment post-injury. 

Research highlights that decreased cognitive functioning, more aggression and anxiety, greater functional disability, slower recovery, and higher rates of suicide attempts have all been found in those that suffer from depression during their recovery from a TBI. Furthermore, a decrease in quality of life, more difficulty managing daily routine, and decreased mobility have also been associated with depression after a TBI.

It is important to speak to your healthcare provider if you have experienced even a minor injury to the head, especially if the injury led to a loss of consciousness. The occurrence of mental health issues, specifically depression, at any point after a brain injury, can have serious negative effects on a person’s ability to recover. Therefore, collaborating with your healthcare team to screen for and potentially address mental health issues after a TBI is imperative to your journey towards regaining a greater quality of life after your injury. 

Symptoms of a traumatic brain injury

Per the National Institute of Health, if you experience any of the symptoms listed below, you should seek immediate medical help:

Physical

• Headache
• Convulsions or seizures
• Blurred or double vision
• Unequal eye pupil size or dilation
• Clear fluids draining from the nose or ears
• Nausea and vomiting
• New neurologic deficit, such as slurred speech; weakness of arms, legs, or face; loss of balance

Cognitive/behavioral

• Loss of or change in consciousness at any point in time
• Decreased level of consciousness (e.g., hard to awaken)
• Mild to profound confusion or disorientation
• Problems remembering, concentrating, or making decisions
• Changes in sleep patterns 
• Frustration, irritability

Perception/sensation

• Light-headedness, dizziness, vertigo, or loss of balance or coordination
• Blurred vision
• Hearing problems, such as ringing in the ears
• Bad taste in the mouth
• Sensitivity to light or sound
• Mood changes or swings, agitation, combativeness, or other unusual behavior
• Feeling anxious or depressed
• Fatigue or drowsiness; a lack of energy or motivation

It should be noted that the symptoms related to emotional regulation, such as mood swings, anxiety, depression, oftentimes occur during the recovery period and not immediately after the injury.

What is clinical depression?

Clinical depression, also known as major depressive disorder or major depression, is a serious mood disorder that can affect your ability to function on a day to day basis. While clinical depression manifests in different ways for different people, most individuals report persistently feeling “low” or “down.” It is easy to see how dealing with clinical depression while attempting to recover from a TBI can make recovery seem almost impossible.

Major depressive disorder is diagnosed when a person experiences five or more of the following symptoms on most days for at least two weeks:

• Persistent, sad, or anxious mood
• Irritability
• Loss of interest in hobbies and activities
• Feelings of hopelessness
• Feelings of guilt, worthlessness, or helplessness
• Feelings of restlessness 
• Fatigue
• Moving or talking slowly
• Difficulty concentrating, remembering, or making decisions
• Difficulty sleeping
• Changes in appetite or weight changes
• Suicidal thoughts

Feeling sad, frustrated, down, overwhelmed, and tired is a normal reaction to a traumatic event such as a bodily injury. The isolation of recovery, getting used to any physical or cognitive impairments that may have occurred due to the event, and the memory of the event itself, all take time to adapt to. 

That being said, if you find yourself experiencing any of the symptoms listed above for an extended period of time, it is important to reach out to your healthcare provider as soon as possible. As mentioned previously, dealing with mental health challenges such as clinical depression while attempting to recover from a TBI, if not addressed properly, can lead to poor clinical outcomes.

What causes depression after a traumatic brain injury?

Physical changes to the brain

It has been proposed that depression is caused by the physical insult that the brain suffers during and after the TBI. There are areas of the brain that are directly responsible for the regulation of emotions, and if the TBI is severe enough, that area of the brain can be affected, changing the level of certain chemicals in the brain that help manage emotional response.

Emotional response to the injury

TBI can lead to serious physical and cognitive disability, such as negatively affecting a person's ability to walk and communicate. A decline in a person’s ability to live the life they once knew while they recover from their injury, especially without attention to their mental health and well-being, can lead to serious emotional challenges. The struggle to adjust to life in recovery, the loss of one’s physical or cognitive abilities, and the unplanned change in one’s role within the family or community, can create an environment in which depression is more likely to occur. 

Factors unrelated to the injury

Some people are at a greater risk of developing depression after a TBI than others. This increased risk is based on variables such as personal or familial history of depression, previous substance use disorder, or the existence of other mental health diagnoses prior to the TBI. There are also several socioeconomic factors that can put a person at a higher risk for developing depression post-injury, such as financial instability and lack of social support. 

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Treatment for depression and traumatic brain injury 

If you are experiencing emotional challenges during the recovery period of your TBI, there is help available. As mentioned above, you are not alone in your experience. Experiencing symptoms of depression is a common occurrence after a brain injury, and with professional help, it is possible to find relief. 

Treatment for depression after a TBI must be handled through a multidisciplinary approach. If necessary, getting the help you need to improve your physical and cognitive functioning, through different types of speech and physical rehabilitation, can help you move towards a better quality of life from a functional standpoint. In order to address the mental health challenges that come with recovery, there are treatment options. 

Cognitive behavioral therapy (CBT)

CBT is a form of talk therapy that helps people address the way they behave, think and feel about things that happen to them, as well as the way they see themselves. This form of therapy has shown great promise in helping individuals that are dealing with depression post-TBI to learn how to better manage their emotions and thinking surrounding their recovery. One aspect of CBT, known as “behavioral activation therapy”, can help increase a person's willingness to engage in pleasurable activities again, despite the challenges that have arisen due to their injury. 

Medications

Antidepressants are commonly used in situations of depression after a brain injury, specifically SSRIs and SNRIs. These medications can help reregulate the chemicals in the brain that have been affected by the injury, the chemicals that have been shown to cause negative changes in the management of emotions. 

Tips for managing depression during recovery 

• Talk to friends and family about how you are feeling, ask for support 
• Try to stay socially connected
• Engage in activities that bring you joy
• Learn more about TBI to get a better understanding of what you are going through  
• Stay physically active 
• Try to identify what is worrying you in your life 
• Create a ‘soothe box’, a physical box that holds items that can calm you 
• Mindfulness and meditation 
• Healthy diet/avoiding drugs and alcohol 
• Use a verified mental health app for support 
• Seek professional help

How Charlie Health can help 

There are a wide variety of talk therapy modalities and medications that are available to help you on your road to recovery. Reaching out to one of Charlie Health’s trained professionals can give you the opportunity to discuss these different options, and will help you learn more about how to better manage your mental health while you focus on getting well. 

It is important to remember that your mental health and well-being is central to recovery from a TBI.  As research shows, time and time again, if you are suffering from depression while you attempt to recover from a TBI, and are not addressing your mental health needs, the road to a better tomorrow may be longer than it has to be. Let the trained professionals at Charlie Health help make the journey forward easier for you. Reach out today.