This is a post that was originally written in 2010. I have updated it a bit and am republishing it because it is so important. I have been struck by the number of people posting on the TBI Survivors Network who appear to be depressed. This concerns me. It appears they are either not being treated for depression at all or are being undertreated.
A multidisciplinary team of researchers at the University of Washington studied 559 adults who have had a traumatic brain injury. They determined that over half (53 percent) of the participants developed major depression in the year following their injury.
High Prevalence of Depression with TBI
“We found a very high prevalence of depression in the months after the head injury,” said Bombardier, “yet only 44 percent of the depressed patients received antidepressant medications or counseling.”
This is especially surprising, he said, because patients with brain injury are seen regularly by health care providers in the months after their injury. Attention is directed to physical and cognitive impairments, he noted. Depression is sometimes overlooked.
Psychological impairments represent significant causes of disability in these patients. Major depressive disorder may be the most common and debilitating of these conditions.
… About half of the patients who became depressed were identified by three months. A window of opportunity might be available for early identification and prevention or treatment.
They note that the risk of major depression persists throughout the first year regardless of pre-injury depression history, and that risk of post-brain injury depression probably persists beyond 1 year. 3
Anxiety Rate 9x Higher with Depression
There has also been an ongoing discussion on the TBI Survivors Network about Anxiety. Many of us report a far higher level of anxiety compared to pre-injury. The study goes on to say:
Patients who had major depression reported a lower quality of life, difficulty managing their daily routine, and less mobility, compared to similarly injured patients who were not depressed. The depressed patients also had a nine times higher rate of anxiety disorders, compared to the non-depressed patients.4
I think there can be increased anxiety without having major depression. I am only surmising that from conversations with other TBI survivors.
Psychological vs Neurological Impairment
One thing that keeps bugging me is this blurry gray line between “Psychological Impairment” and “Neurological Impairment”.
We are talking Brain Injury here folks!
Doesn’t it seem logical that the depression, anxiety, and whatever else could be caused almost solely by microscopic tears in the neural pathways? Elsewhere in the article they mention counseling as one of the treatments for depression.
Counseling vs Medication
I think counseling is very helpful in helping a TBI survivor deal with the changes that the brain injury caused.
However, I am not so sure counseling is an answer for treating depression. In fact I see the treatment for depression as separate, very separate, from the counseling.
If the depression is being caused by neurochemical pathway disconnects or poor production of neurochemicals due to the brain injury itself it seems that neurochemical intervention in the form of medication is the route to go.
The authors of this study are currently conducting another study to examine whether a specific type of counseling called cognitive behavioral therapy is effective in treating major depression after traumatic brain injury. The study is entitled Life Improvement Following Traumatic Brain Injury but more often called the LIFT study. The cognitive behavioral therapy is most frequently being offered in addition to medications. The article closes with the following:
What is the take-home message for people who have had a brain injury?
Fann said that if you can’t seem to get out of a sad mood, if you have trouble enjoying things, low energy, difficulty sleeping, or thoughts of dying or suicide, you shouldn’t simply attribute those difficulties to your brain injury.
“These are not part and parcel of brain injury,” he said. “It’s important not to ignore these symptoms, or to assume they will get better soon on their own.
If you have had a depressive episode in the past, you might be at risk for a recurrence. Talk to your health care provider and ask about screening and treatment options for depression. Treatment can be effective in relieving your symptoms.”4
- Bombardier CH, Fann JR, Temkin NR, Esselman PC, Barber J, Dikmen SS. Rates of major depressive disorder and clinical outcomes following traumatic brain injury. JAMA. 2010;303(19):1938-45. ↩
- Leila Gray, “Major depression is common and disabling after traumatic brain injury” University Week (University of Washington) May 20, 2010 ↩
- ibid. ↩
- ibid ↩
- ibid ↩
- Image of the Depression Eye is by Felipe Morin He calls it The Prison. How true. Used with Permission. ↩
- Image of the hands is most likely from CTBOPKA 34 on Google Plus however he no longer has it in his photos. ↩
- Anxiety Word Image is from The Perimenopause Blog They have good articles on the site. ↩
- Depression Image is from the site LifeHack.org; specifically from an article 64 WARNING Signs of Depression You Need to Be Aware of ↩