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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