Brain Injury and Depression

[♪ Music ♪] [The Brain Injury Research Center] [of Mount Sinai School of Medicine] [New York City] The depression, a lot of that came from the loss of who I was. [presents] My identity as I had known myself ever since finishing my education was through my job and through my accomplishments. It gave me a buffer. It gave me credibility. It gave me identification. It was who I was. That was gone. [Brain Injury and Depression] Hello, I'm Kathleen Watson. I used to be a rehabilitation physician practicing medicine in New York City until I was hit by a motorcycle which left me with a brain injury and unable to continue the practice of medicine. Having been on both sides of the coin, I'm therefore very pleased to present this presentation from the Brain Injury Research Center of the Mount Sinai School of Medicine. The subject of this program is depression after brain injury, and it is very easy to understand how someone can become depressed after a brain injury as the loss makes them feel that they have lost themselves. Depression is very common after brain injury as I think of it as a double whammy. A brain injured person encounters many situations during a day in which their responses are different than what they used to be. These responses can be ones of things they can't do like they can't remember as well or they have difficulty focusing or being organized, or they may be emotional situations. They may find that they lose their temper more often. All of these situations in which a person is confronted with the contrast between the way life is and the way life was are triggers for depression. If you think you are depressed, what can you do to help yourself? We would like to give you a hopeful message as many people have been helped to lead less depressed and more fulfilling lives after a brain injury. Hello? [Kathleen Watson] Jeanie Ring was hit on the head and robbed. Her symptoms began right after her assault, but she didn't realize that it was a head injury. She tried to keep working, but it got too much. Now years later she is back working part-time, but she still feels depressed. The depression, first of all, I feel like it's not going to get better, so I feel very helpless, very hopeless. I feel like I'm just not going to get out of this pit that I'm in, and the pit can be windowless, dark. [Kathleen Watson] Although Jeanie feels trapped by depression, this is not something that she can just snap out of or will herself to change. When Basil Werely had a stroke that disabled him he was an international banker. Several operations later, he finally realized that his old self was gone. After I had my first operation that I can remember the doctors would say, "Well, work hard, and you'll get back close to where you were," but it's been 8 years now, and I have worked hard. I mean, I have gotten out of the wheelchair, and I am walking around on my own, but I'm nowhere near where I was prior to the stroke, so that's kind of disheartening. Seton Melvin was another high-end achiever when she suffered a brain aneurysm. It took her a while to realize how different her life would become from then on. I was depressed. I knew it. The smallest thing, I'd start crying. I slept a lot because of the depression, yet I couldn't sleep when I was trying to sleep because of the depression. [Kathleen Watson] Because your brain has changed and your life has changed drastically simply hoping that your life will go back to the way it was or relying on well-intentioned advice may not be enough. The brain is the foundation of all function and behavior. When it is in a depressed state, it needs rebalancing. There are many paths to success, one of which may be finding the right medication for you. I originally started with Prozac way back when that was just about the only thing around, and I tried Celexa, Cymbalta, and then the other one that is very, very common that's the mirror image of Celexa so I've also done-- I had some reactions to Celexa. I gained a lot of weight on the Prozac. [Kathleen Watson] Seton's response illustrates that it can be a real challenge to find the right drug for you because one medication may work fine while another does not work for you at all or may have side effects. To help her find the right medication Seton went to a specialist in prescribing medication for depression and other emotional disorders. This person is a psychopharmacologist. Depression may be also treated by psychotherapy. This teaches new ways of thinking and coping with the life that arises after a brain injury. At Mount Sinai, we're now conducting research on a form of talk therapy that is found to be very effective in non-injured people. The question is will this be effective in the brain injured person? Also, some people will benefit from the support of others who have sustained brain injuries. A lot of times if I was a little down just talking it out was enough to get me righted again, and what better person to talk to then somebody who understands you? And so my group members became my doctors, actually. [Kathleen Watson] In some parts of the country there may be more medical and support group sources than others. Your doctor, social worker or other therapist may be able to help you find experts and locate support groups in your local community, but you have right in front of you one of the best tools for searching and for linking up with others, the internet. One of the primary aids to help you in finding resources is your state's Brain Injury Association. At the end of this video, we will give you some web links to begin your research. Another useful tip is exercise. We now know that exercise is useful in reducing depression in many people. When I started running for the first time in my life at 34 years of age, well after the operation, I made great leaps in my recovery and my cognition, my ability to sleep and think and mood, and who would have thought that? They didn't tell us. They didn't know that back then. [Kathleen Watson] Research here at Mount Sinai has shown that with at least 30 minutes of fast-paced activity 3 to 4 times per week such as running, walking, swimming, or biking persons with brain injury find themselves less depressed with increased energy and more confidence. Another suggestion is simply adding structure to one's life. This will assist you in increasing your activity level. This in turn may make you feel more positive and less despairing. This might mean developing a schedule of each day's activity. It may mean joining a church group or volunteering. Friends and family may be able to help you find ways to do this that will add meaning and hope to your life. The key points to remember are that there are many avenues to helping yourself: medication, getting regular exercise, engaging in psychotherapy, structuring your daily activities, and getting support of peers. All of these can help you get a grip on depression instead of depression getting a grip on you. And I thought, oh, why didn't I get help for this a long time ago? Why did I waste 3-4 years? [Resources for help: Brain Injury Association of America] [] [Brain Injury Research Center of Mount Sinai School of Medicine] [] [and the Brain Injury Association in your state] [Special thanks to the participating members of New York City's brain injured community.] [♪ Music ♪]

It can be incredibly painful for people with brain injury to be constantly confronted with the contrast with how life is and how life was. These disparities can often trigger depression. Learn why depression after TBI is common and what can be done about it — from people with brain injury to experts in the field.

Wayne Gordon

Wayne Gordon, PhD, ABPP/Cn, is the Jack Nash Professor of Rehabilitation Medicine and associate director of the Department of Rehabilitation Medicine at the Mount Sinai School of Medicine. He is a neuropsychologist and the director of the Mount Sinai Brain Injury Research Center.

Posted on BrainLine August 20, 2012

From the Brain Injury Research Center, Mount Sinai School of Medicine. Used with permission. For more information, go to

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