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Depression after traumatic brain injury
Archives of Physical Medicine and Rehabilitation
Feeling sad and “not yourself” are normal responses to the stresses of recovering from a traumatic brain injury (TBI). But ifthese feelings interfere with your daily life and do not get better over time, you may have depression. This guide will discussthe definition, prevalence, causes, and treatment options for depression in individuals recovering from TBI.
Emotional responses to injury: Adjusting to the physical,
cognitive (mental), and social changes after TBI canlead to depression.
Factors unrelated to injury: Some people have a higher
risk of depression due to genetic predisposition and
other factors that were present before injury.
What can be done about depression after TBI?
Depression is a medical problem, just like high blood
pressure or diabetes. It is not a sign of weakness. You
cannot get over depression by “toughening up.” If you have
depression, it is important to seek professional helpimmediately to prevent needless suffering and worsening
You should seek help if you have 5 or more symptoms of
symptoms. The good news is that, with help, most people
depression several days per week for more than 2 weeks.
If you have specific thoughts of suicide, call your local
crisis line, the National Suicide Prevention Lifeline (1-
Antidepressant medications work by rebalancing the
800-273-8255), 911, or go to an emergency room
natural chemicals (neurotransmitters) in the brain to
improve mood, energy, concentration, sleep, appetite, andanxiety. It is important to know that antidepressants are not
addictive and usually do not need to be taken forever. Since
Depression is very common after TBI.
each person’s situation is unique, always plan your anti-depressant schedule with a doctor.
About half of all people with TBI are affected by
There are many different types or “classes” of antide-
depression within 1 year after injury.
pressant medications. Studies have shown that some classes
About 2 out of every 3 people are affected within 7 years
Selective serotonin reuptake inhibitors (SSRIs) are most
In the general population, the rate of depression is only
effective. Specifically, sertraline (ZoloftÒ) and citalopram
about 1 out of every 10 people over a 1-year period.
(CelexaÒ) have the fewest side effects and can evenimprove cognition (thinking ability) in people with TBI.
Serotonin-norepinephrine reuptake inhibitors (SNRIs),
Physical changes in the brain: TBI can damage emotion-
such as venlafaxine (EffexorÒ), are newer drugs that can
control areas of the brain and can also change the levels of
natural chemicals called neurotransmitters, which play
Some types of antidepressants, like monoamine oxidase
antidepressants (TCAs), should be avoided because they
experience in treating depression can get treatment
If possible, it is best to seek treatment from a compre-
After starting antidepressants, it can take a few weeks to
hensive TBI rehabilitation program that addresses all
feel better. It is important to take your antidepressant
aspects of recovery. You can find accredited programs
medication every day, even if you are feeling better. Do not
stop it abruptly. Your doctor may need to change your dose
Brain injury support groups are another source of
or switch you to a different antidepressant if one isn’t
information and help. Your state chapter of the Brain
Injury Association of America (mighthelp you find one.
For more information about depression, contact the
There are several kinds of psychotherapy, or coun-
National Institute of Mental Health (http://www.nimh.
nih.gov/health/topics/depression/index.shtml) at 1-866-
Cognitive-behavioral therapy (CBT) helps people learn
how to change their behaviors, self-perceptions, andreactions to the things that happen to them. CBT has
been proven highly effective in reducing depression in
This information is not meant to replace the advice from
the general population and is currently under testing to
a medical professional. You should consult your health care
determine the best ways to adapt it for people with TBI.
provider regarding specific medical concerns or treatment.
depression become more active and participate in plea-
surable activities again. This increased activity helpsimprove mood.
Fann Jr, Hart T, Schomer KG. Treatment for depressionafter traumatic brain injury: a systematic review. J Neuro-
For many people, a combination of antidepressant medi-
cation and psychotherapy works best.
Other approaches like exercise, acupuncture, and biofeed-
Our health information content is based on research
back have been shown to decrease symptoms of depression
evidence whenever available and represents the consensus
in the general population. You should consult a professional
of expert opinion of the TBI Model System directors.
specializing in TBI if you are interested in these alternativetreatments.
Depression After Traumatic Brain Injury was developed by
Jesse Fann, MD, MPH, and Tessa Hart, PhD, in collabo-
ration with the University of Washington Model Systems
psychologists, and some social workers or licensed
Knowledge Translation Center. Reproduced from Model
professional counselors) are qualified to treat depression.
Systems Knowledge Translation Center. Copyright ª 2010.
Physicians (primary care physicians, neurologists, and
May be reproduced and distributed freely with appropriate
physiatrists, for example) and nurse practitioners with
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