Brain Injury and Depression: Finding Happiness After TBI

Depression is a common emotional side effect of traumatic brain injury.

Chronic depression can greatly impair a person’s recovery, making it nearly impossible to continue with therapy or exercises. Therefore, it is crucial to seek treatment as soon as possible.

In today’s article, you will learn what the connection is between brain injury and depression. Then, we will look at some of the most effective treatments for depression.

Let’s begin.

Understanding the Connection Between Brain Injury and Depression

The link between brain injury and depression is still not completely understood.

The only fact that is known for certain is that brain injury significantly increases a person’s risk of depression. This is true for both mild concussions and severe, life-threatening brain injuries.

In fact, according to the Mayo Clinic, a TBI patient’s risk of developing depression is two to five times higher than the general population.

While there is still some debate over the precise cause of depression after brain injury, scientists have identified a few factors that can contribute to depression. These include:

• Physical changes in the brain. Damage to the frontal lobe, which regulates emotions, can result in depression. In addition, a brain injury can also disrupt the delicate balance of neurotransmitters in the brain, which can also cause depression.
• Emotional struggles. Loss of independence and problems adapting to a new role can also fuel depression.
• Genetics and other factors. People with a family history of depression before their injury are at a higher risk of developing it after TBI.

Whatever the cause may be, it’s important to be able to recognize the symptoms of depression in order to find treatment.

Symptoms of Depression After Brain Injury

To be diagnosed with clinical depression, a person must experience at least two weeks of feeling sad or apathetic, plus four or more of the following symptoms:

• Significant weight loss or weight gain (5 percent or more in one month)
• Insomnia or excessive sleeping
• Motor agitation (making strange movements without meaning to)
• Speaking or moving more slowly
• Extreme fatigue
• Feelings of worthlessness or guilt
• Decreased concentration or indecisiveness
• Loss of interest or pleasure in usual activities
• Thoughts of death or suicide

Diagnosing Depression After Brain Injury

Unfortunately, most of these symptoms, taken individually, are also common symptoms of brain injury itself. For example, most TBI patients struggle with concentration and decision-making problems.

In addition, some conditions such as adynamia, which causes low motivation, can look a lot like depression. But it is a completely separate issue that requires a unique approach to treatment.

All of this makes diagnosing depression after brain injury a more complicated endeavor than one might expect. However, one of the key signs of depression is losing interest in activities you once enjoyed.

Some change is natural after brain injury, of course. For example, you may not enjoy going to loud and crowded bars anymore because your brain is more sensitive to noise. But if you can’t find enthusiasm for anything, you may be suffering from depression.

Treating Depression After Brain Injury

There are many options available to help you treat depression after brain injury. The two most widely-recommended treatments are antidepressant medications and psychotherapy.

Most TBI patients will need a combination of medications and therapy before they see improvements. The following are some of the different types of medications and therapies you can use to treat depression.

Medications

Antidepressants help regulate the level of neurotransmitters in your brain. They are not addictive, and usually only need to be taken for a few months.

Every person reacts differently to antidepressants though, so be sure to only start them under supervision of your doctor.

There are several classes of antidepressants that each have a different effect on the brain. Therefore, TBI patients should exercise caution before choosing one.

The safest and most effective antidepressants for TBI patients are selective serotonin reuptake inhibitors (SSRIs). These have the fewest side effects and may even improve cognitive function.

SNRIs (selective norepinephrine reuptake inhibitors) are also sometimes used for brain injury patients. However, because they are newer drugs, there is not as much research on their effects on TBI.

The most common antidepressants prescribed to brain injury patients are:

• Fluoxetine hydrochloride (Prozac)
• Sertraline (Zoloft)
• Fluvoxamine (Luvox)
• Venlafaxine (Effexor)

TBI patients should avoid certain classes of antidepressants, called monoamine oxidase inhibitors (MAOIs), whenever possible. These can cause sedation which can worsen cognitive dysfunction.  

Cognitive-Behavioral Therapy

Talk therapy and counseling are probably the best treatments for depression. There are several different types of talk therapy out there, but the most effective one for brain injury patients seems to be cognitive-behavioral therapy.

Cognitive-behavioral therapy is the most scientifically verified psychotherapy treatment, with over 1,000 studies on 10,000 patients, all demonstrating its effectiveness. It’s been successively used on a variety of disorders, including traumatic brain injury.

CBT seeks to help people understand their own behavior by becoming more aware of their mental state.

Cognitive-behavioral therapy is based on three core principles:

• Beliefs create feelings
• Feelings dictate behavior
• Behavior reinforces beliefs

Therefore, to get to the root of the problem, most CBT treatments focus on uncovering unhealthy thinking patterns.

For example, if a person struggles with depression after TBI, most likely there are some negative beliefs fueling their feelings. A therapist might help the patient discover which underlying beliefs are worsening their depression.

The next step is to learn how to defeat these unhealthy beliefs. CBT therapists help patients do this through two approaches:

• Cognitive restructuring. This technique helps patients learn how to identify “automatic thoughts” and question them before they take root. Then, the therapist helps the patient find a more positive interpretation of their thoughts.
• Behavioral activation. This technique helps people plan and initiate positive activities to improve their mood, such as going for a walk or meditating. It also targets harmful behavior that only worsens symptoms, such as social isolation and inactivity.

This strategy is especially effective for people with traumatic brain injuries. Because a brain injury often causes low motivation, it can help to have someone hold you accountable.

Using Positive Psychology for Depression After TBI

While medications and talk therapy are helpful treatments, there are also techniques you can use every day at home to boost your happiness and ward off depression.

These techniques are known as positive psychology, which seeks to build up internal strength by developing a more optimistic attitude.

Positive psychology can be practiced by using five simple methods:

• Three good things. At the end of each day, write down three good things that happened to you. Or if you can’t think of anything, write three things that you are grateful for. This helps you learn to think more positively.
• Gift of time. Spend time with three different people this week, either by helping them with chores or just sharing a meal.
• Use your strengths. Take a survey that asks you about your character strengths, and find new ways to use your strengths each week. If you have trouble coming up with ideas, check out these tips.
• Counting kindness. Keep track of kind deeds that you perform each day. Write down what you did and how it made you feel.
• Gratitude letter. Write a letter to someone who you feel has had a positive impact on your life. You do not have to send the letter if you do not want to.

Of course, these tips should not replace traditional treatments for depression. But they can help you retrain your brain to appreciate the little things in life, which science has shown can boost your overall happiness.

Overcoming Depression After Brain Injury

Depression can be a debilitating condition for brain injury patients. But even if things seem darkest right now, there is always hope for improvement.

The best thing you can do is schedule an appointment with a neuropsychiatrist right away. Whether you need medication or talk therapy or both, a therapist familiar with both brain injury and depression should be able to get you started on the right path to recovery.

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