  Depression is a common experience following an Acquired or Traumatic Brain Injury (ABI or TBI). Following Acquired Brain Injury a person is 7.5 times more likely to develop major depression than the general population1.
- What is depression?
- Why depression occurs following acquired brain injury?
- Personal coping strategies for depression
- Treatment options for depression
- How friends and family can help?
What is depression?
Depression is a mood state, during which a person may feel ‘low,’ ‘down,’ ‘negative’ and generally unhappy about themselves, the world and their future. Two reliable symptoms of depression are feelings of worthlessness and hopelessness. The symptoms of depression may range from mild, where a person may still be able to function in day to day life, but generally feel ‘low,’ to severe and debilitation depression.
Common Symptoms:
- Mood e.g. sadness, despair, flat emotional reactions and increased irritability
- Thinking patterns e.g. a sense of hopelessness, pessimistic beliefs
- Behaviour patterns e.g. reduced attention to Physical appearance, withdrawal & loss of motivation to participate in activities they used to enjoy.
- Physical symptoms e.g. sleep disturbance, appetite changes, and tiredness.
For a person with an acquired brain injury other signs of depression may include:
- A gradual decline in ability to perform everyday tasks
- Decline in ability to cope with every day stressors
- Increased irritability and behavioural issues e.g. anger, Frustration, agitation
Depression can exaggerate the effects of acquired brain injury and interfere with progress made during rehabilitation. So it is important that family be aware of the symptoms of depression. The good new is that once detected, depression is both manageable and can treatable with the support of family, carers and professionals. Most people will feel periods of despair following a brain injury, this is normal, however when it begins to seriously interfere with progress and functioning, treatment should be sought.
Depression following acquired brain injury
There can be multiple triggers or causes of depression following acquired brain injury. One obvious cause is the significant loss and change an acquired brain injury can introduce to a person’s life. These changes can include those related to physical and Cognitive functioning, social roles and or lifestyle changes.
Depression can occur at any stage following an acquired brain injury, from the acute hospital stage to many years post-injury.
- Depression in the early stages of Recovery can be a sign the person is developing awareness of the deficits associated with the brain injury. This can be a promising sign for the rehabilitation process, as the person can identify and work on areas needing attention 2.
- A person may be at increased risk of depression following discharge from hospital when they resume life back in the community. They may have completed formal rehabilitation and rate of recovery has started to slow. During this time a person may realise the full nature of the effects of the ABI on their daily life.
- During the process of adjustment and coming to terms with sustaining a brain injury it is normal for a person to go through a period of depression.
Depression following ABI or TBI is also related to other factors including 3
- Social isolation
- Sleep difficulties
- Difficulties in maintaining employment and relationships post-injury
- Location of the injury. If a part of the brain responsible for controlling mood is damaged their may be increased risk of depression.
- History of mental illness or Substance abuse prior to the injury
- Other health conditions that may cause or exacerbate the symptoms of depression, e.g. thyroid problems, chronic pain, pituitary
- Medications – certain types of medication can cause symptoms of depression.
Assessing Depression Following Acquired Brain Injury
Clinical Psychologists and clinical neuropsychologists are experts in the assessment and treatment of mental disorder. Diagnosing depression can be complicated and easily misdiagnosed following acquired or traumatic brain injury due to the overlap in symptoms. For example, fatigue, irritability, poor motivation, slow information processing and changes in appetite are all symptoms of depression and traumatic brain injury. A professional with good knowledge of acquired brain injury is required when providing an assessment for depression in a person with ABI.
Professional Treatment Approaches for Depression
Professional help and treatment is advisable when depression becomes a problem. In 2006 Medicare introduced Psychological treatment by a registered psychologist as part of the better access to mental health services scheme. A person assessed as having a mental health problem can now be referred by a GP to a registered psychologist under a Mental Health Care Plan. This means a person can receive a rebate on the cost of psychological treatment by a psychologist.
To be considered for this scheme you need to be referred by your GP, a psychiatrist or a paediatrician. You may need to book a longer session with a GP, as they will need to complete a detailed mental health assessment prior to considering a referral.
Types of Treatment:
- Cognitive Behavioural Therapy
- antidepressant medication
Personal Strategies for Coping with Depression
- Getting adequate sleep
- Listening to music
- Avoid drugs and alcohol which can worsen the effects of depression
- Working on a personal project or hobby
- Walking or other exercise
- Mental stimulation (which will also assist with cognitive rehabilitation)
- Scheduling activities and making short-term plans
- Each a nutrient rich diet – studies have indicated Omega-3 can assist with depression
- At the end of each day write in a diary five things you are grateful for
- Use positive self-talk – ‘I can cope, I can manage this’
Other useful techniques are listed below:
Thought Challenging:
Thought challenging is a useful technique for modifying inaccurate and upsetting thoughts, which are common in depression. It requires replacing upsetting thoughts with constructive explanations or more rational thoughts. You may like to keep a diary to monitor and assess your negative thoughts. A diary may include the place/event, the thoughts that arose and the feelings and actions that resulted. This may help you to become aware of patterns in your thinking, which may be destructive or biased.
Some examples of negative thought process:
- Positive events attributed to external factors/an accident/luck
- Negative event attributed to personal characteristics/faults
Next time something positive happens that you were involved in, make sure you give yourself a pat on the back and let your self know what a good job YOU did.
Peer support:
Do not underestimate the importance of social contact for the maintenance of good mental health, including depression. Social contact, and in particular peer support, is often of immense help to someone with depression. Your local brain injury association or mental health association can put you in touch with peer support groups for brain injury or for depression.
Exercise:
Research indicates that exercise alleviates the symptoms of depression. Even 10 minutes walk per day can be beneficial to your mood.
If you are currently recovering from physical injury or physical deficits as a result of a brain injury, discuss any exercise program with your GP or rehabilitation team.
How friends and Family can help
- Exercise active listening skills.
- Do not make judgmental or critical statements e.g. just ‘get over it’ or ‘its not that bad.’
- Help your loved one schedule in activities for each day
- Reinforce any positive coping mechanisms the person is using e.g. talking, exercising, going for walks etc
- Provide plenty of encouragement and praise following achievement of tasks during the day.
- Encourage them to seek help from a counsellor or psychologist
Suicide Risk
In cases of severe depression it is important for family and friends to be aware of any signs of suicide risk. If suicidal thoughts are present it is important to encourage the person to seek help from a GP or psychologist. Warning signs to look for include:
- Statements like ‘It would have been better if I had died’ or making threats about committing suicide.
- Suddenly and unexpectedly becoming cheerful after a long period of depression (which may indicate the individual having decided to use suicide as a solution).
- If the person with Acquired Brain Injury has tried to commit suicide before, you should particularly be aware of cues and try to assist them to seek professional help.
- Having a plan for suicide, and the means to achieve it.
It is particularly important to realise that the existence of an achievable plan must be taken seriously. All suicidal comments need to be addressed, but having a plan and the means to achieve it is a sign that professional help needs to be sought as a matter of urgency. If the situation is critical, call 000.
Also see fact sheet, “Suicide, Depression and Brain Injury .” http://braininjury.org.au/portal/psychological/suicide-depression-and-brain-injury---fact-sheet.html
References
- Royal Adelaide Hospital Brain Injury Rehabilitation Service. (2009). Emotional Disorders Following Acquired Brain Injury. Retrieved June 1, 2009, from http://www.rah.sa.gov.au/birs/bi_emotional_disorders.php#depr
- Brain Injury Association USA (2004). Coping With Depression after Traumatic Brain Injury: Living with Brain Injury. Retrieved June 4, 2009 from http://www.biausa.org/elements/BIAM/2004/depression.pdf
- Elbaum, J & Benson, D. M. (2007). Acquired Brain Injury: An Integrative Neuro – Rehabilitation Approach. Springer Publishers.
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Depression and brain injury