Over two million Americans have some form of a traumatic brain injury annually. Like so many aspects of brain injuries, depression is something that while not easily quantified, is prevalent. Findings from one study revealed that over fifty percent of individuals with a TBI present with major depressive disorder following injury. Although t might be cliché to say “it depends,” that is often the truth. Many times, aspects of a person’s personality may be heightened after injury. Thus, if an individual has a history of depression or mental illness before the injury, the presence of depression after injury may be quite strong. This isn’t just a potential struggle for the individual, but also for their family. Often, as they see their loved one emerge from post-traumatic amnesia and begin to understand the implications of the injury, loved ones will notice a decline in the individual’s mood.
Brain injury can result in changes to an individual’s physiology, meaning that depending on the injury itself, an individual’s awareness of depression may vary significantly from case to case. Someone with a more severe injury and who is unaware of their deficits, may not present as many symptoms of depression as someone with greater deficit awareness. The ability to observe and reflect on one’s
actions and feelings is a crucial piece of awareness that promotes adjustment. Depending on the injury itself, an individual may not recognize their depression due to this lack of awareness. Emotional processing can present in many ways depending on the injury and the person. To name a few, emotional presentations can include being blissfully unaware, emotionally flat, not feeling emotions as strongly as before, experiencing depression, or having exaggerated frustration.
Among many key avenues of treatment for depression after brain injury is medication—though in many ways even medications correspond with an individual’s recovery. Depression after brain injury must be treated carefully, due to physiological changes. Medications can be less predictable after injury and often necessitate time and substantial knowledge on the part of the treating provider’s. From a psychological standpoint, treatment should include an educational aspect aimed at normalizing the experience of depression as a part of the recovery journey. For family and loved ones, explaining how concerning behaviors and changes in mood are related to injury and the subsequent recovery process can help increase understanding, compassion, and ultimately support. At QLI, psychologist Dr. Pamela Payne often works with clients not only to identify the triggers of depressive spells but also to “reengage their parasympathetic nervous system,” by incorporating grounded breathing techniques, allowing an individual to calm down and begin processing difficult emotions. The parasympathetic nervous system is essentially the inverse of the sympathetic nervous system or a fight or flight response. While the sympathetic nervous system can stimulate and heighten emotions, the parasympathetic nervous system assists in calming that arousal.
Another significant component in navigating depression after brain injury is to help individuals adjust their sense of identity and perceptions about a meaningful future. “It is common after a life-changing injury,” notes Dr. Payne, “for an individual to demonstrate hopelessness due to aspects of their life plans having changed such as their dreams, goals, and aspirations. While acceptance of injury-related changes takes time and support, gaining an understanding that, while many things have changed, a personally meaningful future can still be attained is powerful for an individual in recovery. Often an individual may worry about how their family or friends will now perceive them or about being a burden to 
them, when in fact both things are far from the truth. Therefore, education and openly processing these notions can show individuals that their goals are still attainable and that their support system remains strongly by their side—essentially, that they still are who they are and can grow and adapt in their recovery.
The truth is that, depression after injury is not something that can be easily dealt with, and yet it is also a fairly normal part of injury rehabilitation—it takes time. In some respects, rehabilitation can be likened to a marathon—providing the understanding that hurdles lie ahead, including difficulty with one’s mood. However, with the right team and support systems, the marathon is manageable. Dr. Payne notes that when an initial psychology screening is done during the early stages of a client’s inpatient rehabilitation, many people self-report that they are not experiencing depression. “There may be pressure,” says Dr. Payne, “to get caught up in the initial optimism and hope of admitting to a new facility—if perceived as a negative and a drawback, an individual in recovery may fear being judged for their emotional expressions, and might believe it will hinder their recovery.” Perceptions such as these may or may not be brought up depending on the awareness of the individual. Part of the process of taking the time needed to heal means that it is necessary to ensure the feeling of safety in the environment. This allows for more in-depth explorations of post-injury feelings followed by appropriate treatment recommendations.
Among the many resources that exist to help with the treatment of depression after injury is the Brain Injury Alliance. Others resources include books such as Floating Feathers. “Memoirs written by those who have had these experiences are tremendously helpful,” says Dr. Payne. “These validate the recovery experiences. Additionally, when individuals who are further along in their rehabilitation journey encourage those still earlier in the process, the response can be incredibly powerful. Finding one’s peers
and sharing in each other’s experience is incredibly helpful in reducing loneliness and helping a newly injured individual incorporate their injury into who they are personally while gaining hope through seeing the progress of another who has been there before them. Essentially, when someone can feel understood, even if they don’t have the words to express that understanding, a powerful step toward healing has occurred.”
For more on QLI’s brain injury rehabilitation program, click here.
Categories: Brain Function, Brain Health, Brain Injury, Mindfulness, Neuroscience