Understanding the Link Between Brain Injury and Depression: Causes & Treatment Methods

After sustaining a traumatic brain injury (TBI), survivors may feel blue, tired, or sad, which are all common symptoms of depression. However, it’s important to understand the link between brain injury and depression to identify the signs and seek proper treatment.

While depression may be caused by other contributing factors, a TBI can increase the risk of developing it. This effect can interfere with daily activities and life as a whole, but fortunately there are ways to overcome it. 

This article will discuss the connection between brain injury and depression, exploring the causes, symptoms, and most effective treatments.

What Causes Depression After Brain Injury?

Depression is characterized as a major mood disorder that can negatively impact your daily activities and quality of life overall.

Brain injuries, from mild concussions to more severe trauma, can all increase the risk of developing depression. In fact, studies show TBI survivors are two to fives times more likely to get depression than non-TBI individuals.

While the exact cause of depression after brain injury depends upon the unique circumstances of every survivor, scientists have identified a few contributing factors, which include:

• Physical changes in the brain. When the frontal lobe, an area of the brain responsible for regulating emotions, sustains an injury, it can result in post-TBI depression. This is due to a disruption in the balance of neurotransmitters, or chemical messengers.
• Emotional struggles. Depression may also arise from a survivor’s mental and emotional struggles, especially when adjusting to life after brain injury, which may involve adjusting to limited abilities.
• Genetics and other factors. Individuals with a family history of depression may be at a higher risk of developing depression after TBI.

It helps to work with a medical professional to obtain a proper diagnosis and better determine if the cause of depression is TBI or other contributing factors.

Common Signs and Symptoms of Depression After Brain Injury

An adequate diagnosis of clinical depression usually has two requirements: at least two weeks feeling sad or apathetic, and experience four or more types of symptoms including:

• Extreme fatigue
• Speaking or moving more slowly
• Decreased concentration or indecisiveness
• Loss of interest or pleasure in usual activities
• Insomnia or excessive sleeping
• Significant weight loss or weight gain (about 5% percent or higher in a single month)
• Motor agitation (unintentional or purposeless motions)
• Excessive crying or irritability
• Feelings of worthlessness or guilt
• Suicidal thoughts or death

The National Suicide Prevention Lifeline provides free and confidential emotional support 24/7 to everyone in the United States. If you are having thoughts of suicide, please call the suicide hotline at 1-800-273-8255.

Sometimes, depression symptoms may look similar to other conditions such as adynamia, or lack of motivation. However, these are two different effects of TBI that are treated separately, according to the causes they stem from.

One noticeable difference in differentiating between depression and other conditions is the loss of interest in your most favorite activities. 

It’s understandable, after having sustained a brain injury, to not enjoy loud or crowded places as much, especially if the brain is sensitive to noise. However, when participating in activities that you once enjoyed seems like a drag or you’re simply not interested, it may be a sign of depression.

How to Cope with Depression Post-TBI

There are several methods to help treat depression after brain injury. Two of the most popular treatments include antidepressant medication and psychotherapy.

The following are some of the most effective types of medication and therapy to help treat depression.

Medication

Antidepressants are amongst the most common medications given to individuals with depression. It helps regulate the level of neurotransmitters in the brain. They can be taken for a few months, depending on the severity and your doctor’s recommendations.

Everyone may react differently to antidepressants so it’s important to keep track of any side effects you may experience and consult with your doctor or psychiatrist.

There are also several classes of antidepressants that can create a different impact on the brain. Two common types are selective serotonin reuptake inhibitors (SSRI) and selective norepinephrine reuptake inhibitors (SNRI).

SSRIs are one of the safest and most effective medications for TBI survivors. These tend to have minimal side effects and may even help improve cognitive function. For example, two popular antidepressants prescribed to treat depression are Fluoxetine hydrochloride (Prozac) and Sertraline (Zoloft). Fluvoxamine (Luvox) can also help treat depression as well as OCD, another potential secondary effect from brain injury.

Sometimes SNRI are used to treat depression after brain injury such as Venlafaxine (Effexor), which is also used to treat anxiety and panic attacks. However, because SNRI are newer drugs their side effects are still undergoing research.

Certain classes of antidepressants such as monoamine oxidase inhibitors (MAOI) should be avoided when possible because they can cause sedation and worsen cognitive function.

Cognitive-Behavioral Therapy

Psychotherapy, also known as talk therapy, is one of the best approaches to treating depression and other mental or emotional difficulties after TBI. While there are various forms of psychotherapy, the most effective treatment for brain injury survivors is cognitive-behavioral therapy (CBT).

One of the goals of CBT is to get to the root of cognitive and behavioral difficulties after brain injury based on three core principles: 1) beliefs create feelings, 2) feelings dictate behavior, and 3) behavior reinforces beliefs. Many treatments focus on helping survivors become more aware of their mental state and uncover unhealthy thinking patterns.

For example, a survivor struggling with depression after TBI may have negative beliefs, such as worthlessness or guilt, fueling certain feelings. A CBT therapist might then try to help the survivor dig and search for underlying feelings that are triggering depression. Two common approaches to help survivors achieve this are cognitive restructuring and behavioral activation.

Cognitive restructuring is a technique that helps survivors learn how to identify “automatic” or irrational thoughts, and address them before allowing them to take over their actions. This can help survivors interpret thoughts with a more neutral, positive approach.

Behavioral activation is another technique that helps survivors initiate and plan positive activities to improve their mood. This can include simple activities such as going for a walk or meditating. Behavioral activation can also help target harmful behaviors that can enhance symptoms of depression or other disorders such as social isolation or inactivity. This technique is especially attractive for brain injury survivors struggling with adynamia, or low motivation.

While there are various treatments for brain injury and depression, some survivors may benefit from a combination of methods to enhance improvement. Consult with your doctor or psychotherapist to find the best approach(s) for you.

The Benefits of Positive Psychology After TBI

In addition to medication and talk therapy, another method used to help with depression after brain injury is positive psychology. 

Unlike traditional psychology, positive psychology focuses on forward-thinking and expanding on positive, therapeutic processes. It aims to help survivors create positive thoughts and feelings, like gratitude, and improve overall mood by rewiring the brain through neuroplasticity.

Neuroplasticity is the brain’s ability to rewire itself and improve certain functions. It can be summarized by the phrase “you are what you repeatedly do.” Positive psychology aims to harness neuroplasticity by training your brain to focus on positive thoughts and boost positive feelings.

The most simple yet effective positive psychology practice is writing in a daily gratitude journal. At the end of each day, write down three good things that happened to you, or write three things that you are grateful for. This will help train your brain to seek out and notice things that are positive.

Overcoming Depression After Brain Injury

There are many secondary effects survivors may experience after brain injury and depression can be one of them. Fortunately, there are just as many ways to overcome these effects and improve function and quality of life overall.

Consult with your doctor or therapist first to learn how to identify the symptoms of depression or other disorders and obtain a diagnosis, if any. Your medical team can create a treatment plan most suitable for you, which can include a combination of medication, cognitive-behavioral therapy, and positive psychology.

With the proper treatments and techniques, you may be able to overcome the effects of brain injury and depression and soon return to your most favorite activities.