Depression After Brain Injury

Agency for Healthcare Research and Quality
Depression After Brain Injury

A Guide for Patients and Their Caregivers

Is This Guide Right for Me?

Yes, if:

  • You have experienced a mild, moderate, or severe injury to your brain due to a sudden trauma. This guide is for you even if you did not see a doctor at the time of the injury.
  • A doctor or health care professional has told you that you have suffered a brain injury.
  • This guide is for you even if you have not felt depressed since your brain injury.

Where does the information for this guide come from?

The information in this guide comes from a review of many studies about traumatic brain injury and depression. The review was conducted by an independent research center and was paid for by the Agency for Healthcare Research and Quality, a research agency of the U.S. Government. You can read the full report at www.effectivehealthcare.ahrq.gov/tbidep.cfm.

Understanding Your Condition

What is traumatic brain injury?

Traumatic brain injury (TBI) is the medical term for when your brain is injured by some force, such as:

  • A direct hit to your head by an object.
  • A fall to the ground or a hard surface.
  • A car, motorcycle, or bike crash.
  • An explosion or a blast very close to your head.

Doctors can tell whether your injury is mild, moderate, or severe based on what happened at the time of your injury (if you were knocked out, if you had trouble seeing clearly, or lost some memory) and by other tests. Around 1.5 million people who are not in the military experience some form of TBI each year in the United States. It is likely that more people are affected, because many people with mild TBI do not go to the emergency room or report their injury. Most TBI cases (75 percent) are mild.

Problems Caused by TBI

Any injury to your brain — even if it is mild — can cause problems such as headaches, ringing in your ears, mood changes, or trouble remembering or thinking for long periods of time. You may have found that your sleeping habits are different or that you feel tired more often.

Even several months or years after your brain injury, you may notice other difficulties, including depression or anxiety.

Depression and TBI

What is depression?

Depression is more than feeling sad every now and then. It is normal for someone who has had a TBI to feel sad by the problems caused by this injury. But for some people, those feelings can extend beyond normal feelings of sadness. People with depression feel sad, lack energy or feel tired, or have difficulty enjoying routine events almost daily. Other symptoms include difficulty sleeping, loss of appetite, poor attention or concentration, feelings of guilt or worthlessness, or thoughts of suicide.

How common is depression for people with TBI?

Research has found that patients with TBI are more likely to experience depression than those who have not had a brain injury.

For every 10 people who do NOT have a brain injury, approximately one person will have depression.

For every 10 people who DO have a brain injury, approximately three people will have depression.

What increases my risk of depression?

The risk of depression after a TBI increases whether the injury is mild, moderate, or severe. Researchers cannot say if age, gender, the part of the brain that was injured, or the type of injury makes depression more likely.

How soon after my injury might I become depressed?

Researchers do not know when depression is most likely to occur after TBI. Some people experience depression right after their injury, while others develop depression a year or more later. It is important to tell your doctor about any symptoms of depression you may be having even if it has been a while since your head injury. Your doctor or health care professional will ask you a series of questions or have you fill out a questionnaire or form to see if you have depression.

How can I tell if I am depressed?

There are ways to tell if you are depressed.

  • Feeling down, depressed, or sad most of the day.
  • Changes in your sleeping habits, such as sleeping poorly or sleeping more than usual.
  • Losing interest in usual activities such as favorite hobbies, time with family members, or activities with friends.
  • Increasing your use of alcohol, drugs, or tobacco.
  • Not eating as much or eating more, whether or not you are hungry.
  • Strong feelings of sadness, despair, or hopelessness.
  • Thoughts of suicide.

You may not notice some of these symptoms, but people living and working around you may see them. You may want to ask the people close to you if they notice these signs in you.

What should I do if these symptoms start to occur?

Tell your doctor or health care professional as soon as you or others around you notice any symptoms.

Understanding Your Choices

How is depression treated?

Depression is usually treated two ways:

  • Personal counseling with a special kind of health care professional. This is called “psychotherapy” (pronounced si-koh-THER-uh-pee).
    • In psychotherapy, you and a trained health care professional talk about your symptoms and how to develop ways to deal with them.
    • You might meet with your therapist weekly for several months or longer, depending on how you feel.
  • Medicines called “antidepressants” (pronounced an-tee-dee-PRESS-uhnts).
    • Several types of antidepressants are used to treat depression and anxiety.
    • You might need to take these medicines for several months or longer, depending on how you feel.
    •  

Many times, people need both psychotherapy and medicines.

Researchers do not know the specific benefits and harms or side effects of psychotherapy and antidepressants for people with TBI. However, both psychotherapy and antidepressants have helped people with depression.

Are there any side effects from antidepressants?

All antidepressants can cause side effects.

Researchers do not know if the side effects are different for people with TBI than for other people who take antidepressants. However, research found that for some people antidepressants can cause:

  • Stomach or intestinal pain and diarrhea.
  • Weight gain or weight loss.
  • Nausea and vomiting.
  • Sexual problems.
  • Trouble sleeping or sleepiness during the day.

Talk to your health care professional about the possible side effects of antidepressant medicines.

One special concern for people with TBI is how antidepressants may affect other medicines they take for their brain injury. It is important to tell your doctor or health care professional about other medicines you take.

Your health care professional can help you decide

Tell your health care professional:

It is important that you contact your health care professional when you experience:

  1. Changes in sleeping or eating habits.
  2. Frequent feelings of sadness, hopelessness, anxiety, or panic.
  3. Disinterest in your favorite activities.
  4. Thoughts about suicide.

Ask your health care professional:

Here are some questions you may want to ask your health care professional if you are going to be treated for depression or anxiety following your brain injury:

  1. How often should we check to see if I am developing depression or an anxiety disorder?
  2. How long do you think I will need psychotherapy or medications to treat these problems?

Sources

The information in this guide comes from the report Traumatic Brain Injury and Depression. It was produced by the Vanderbilt University Evidence-based Practice Center through funding by the Agency for Healthcare Research and Quality (AHRQ). Information about the side effects of antidepressants comes from the report Comparative Effectiveness of Second-Generation Antidepressants in the Pharmacologic Treatment of Depression. It was produced by the RTI International–University of North Carolina Evidence-based Practice Center through funding by AHRQ. For a copy of either of these reports or for more information about AHRQ and the Effective Health Care Program, go to www.effectivehealthcare.ahrq.gov. Additional information for this guide came from the Medline-Plus Web site, a service of the U.S. National Library of Medicine and the National Institutes of Health. This site is available at http://www.nlm.nih.gov/medlineplus/traumaticbraininjury.html.

This summary guide was prepared by the John M. Eisenberg Center for Clinical Decisions and Communications Science at Baylor College of Medicine, Houston, TX.

Posted on BrainLine May 13, 2011

From the Agency for Healthcare Research and Quality. Used with permission. www.ahrq.gov.

Comments

Whatever improvement I experienced after my TBI was within the first year or two, since then with limited legal and health insurance resources things have been going steadily downhill. The worst part was being prescribed addictive meds that made things worse by so called professional MD PhD's. 

We have lost years of our lives due to doctors who don't understand how to treat depression or to look for links with head injuries and testosterone. I'd encourage everyone to go to as many different doctors as possible -- searching for answers. Never trust one. Our primary care physician was wonderful but too cautious in prescribing therapeutic doses. The first (idiot) psychiatrist suggested shock therapy as the only remaining answer, without asking if there was a past head injury (we left him). And that same psychiatrist never suggested medical checks. A head injury, even 20 years ago can lead to depression. Any professional worth their salt would ask lots and lots of questions and order tests. Check testosterone, check family history, check concussion history -- sadly, we have to be our biggest advocates now.

What do you do when the medications have made you unwell, and there is no longer any trust in Doctors? I was nearly killed by a neuroscientist pulling me off an ssri way too fast. They are known for increasing suicide and that's all over the press these days.  I got better with a herbalist - unfortunatately other people got me off those herbs and I went back to square one.

Herbs should be used from the word go, and not these hellish chemicals that make other's huge profits. Psychiatry joined at the wallet with big pharmer.

I have suffered a brain injury 2 years ago which was caused by an accident in which there was a rapid deceleration and there was freezing waters so the body and brain suffered hypoxia. . There was someone who tried to revive me but I was not responding and was taken to hospital where they got the resuscitation team to help bring me back to life. I am now suffering from the eyes and ears not registering anything that I do to the brain. I have lost all my memories of my life and now cannot take in anything new. I would like some kind of Help With This But The Doctors Dont Seem To Listen In This Country Where As You Try And Seek HELP In Another Country And The Brain professor Understands You. Depression is not something that all GP's understand and they should not be in the profession if they don't. I feel let down by the GP'.

My son was on a motorbike in Thailand last November 2013 when he was attacked by eleven teenagers ages 13 to 19 on seven motorbikes.  They went after my son, knocked him off his motorbike and they proceeded to surround him and repeatedly kicked him and hit him with a beer bottle until they thought he was dead.  A witness called police and ambulance.  My son was unconscious and was transferred to a hospital and placed in ICU/in a coma/intubated and unable to breathe on his own, a collapsed lung, four broken ribs and many areas where the skin was sheared off of him all on the right side.  His main diagnosis DAI (diffuse axonal injury).  He went through hell and back after coming out of the coma and had to be vest restrained and wrist and ankle restraints for a long, long time.  I went to Thailand when he was first injured thinking it was to say that I loved him and to tell him goodbye but by the grace of God he did not die.  I had him placed in a US hospital where he was still in unstable condition and needed much therapy.  Now, it is July 2014 , eight months after the attack.  My son's mind and his thinking goes in ten different ways, he is depressed most of the time, has headaches, legs hurt, he feels helpless, becomes easily aggitated and now has no therapy, he is out of meds except his Depakote so being off medication and unable to see a neuro specialist and psychiatrist etc.makes life difficult for him and for me.  We are hoping he will be approved for disability so he can get the help he needs.  My son's depression has not gotten any better since he learned to walk so I am praying for him that he will get the help he needs.  It seems after reading BrainLine there are many many others suffering from depression and it would be truly great if many readers would write in and tell us what you did to help yourself to get better.

TBI in 1994. CBT and medications. I honestly don't think it is treatable. It is not as debilitating as at first but still a struggle.

CBT is nothing new for depression of TBI survivors. Its been around for 20 plus years. I suffered my TBI in 1991 and recieved CBT treatment for a year and I still suffer from TBI related depression.
I am a TBI survivor with symptoms of depression. The NIH is currently studying the effectiveness of CBT as a treatment for TBI survivors with depression: http://clinicaltrials.gov/ct2/show/nct00878150?term=life+improvement

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