Traumatic brain injury (TBI) occurs when an external mechanical force on the head damages the brain, causing disruption to normal functioning. The trauma can be the result of a violent blow or jolt to the head or body or from an object penetrating the skull, such as a bullet or shattered piece of skull, causing bruising, swelling or tearing of brain tissue. The injury may be confined to one area of the brain or may involve multiple areas.
Not every blow to the head results in a TBI. When the impact is sufficient to cause damage to the brain, the extent will range from mild, which is likely to cause temporary dysfunction, to severe, which could include an extended period of unconsciousness, memory loss and physical damage to the brain that can result in long-term complications or death.
Traumatic Brain Injuries and Antidepressants
What is not always recognized is the extent to which serious head trauma that results in traumatic brain injury also brings with it the likelihood of the individual developing major depression. A TBI can take a long time to recover from and require extensive periods of medical care. All areas of life are disrupted. Estimates vary, but it is believed that half of those who experience TBI will become depressed sometime within the first year following the initial injury. This is equal to eight times the rate of depression in the general population.
According to a study published in the Journal of the American Medical Association (JAMA), only about 45 percent of TBI sufferers who do become depressed are likely to receive adequate treatment. Charles Bombardier, Ph.D., professor of rehabilitation medicine at the University of Washington School of Medicine and author of the study, made the statement, “We’re not talking about normal day-to-day changes in mood, but symptoms that last for more than two weeks.”
The symptoms that Dr. Bombardier referred to can range from low energy, moodiness, inability to focus or concentrate, restlessness, feelings of guilt and worthlessness all the way to thoughts of death. In fact, studies show there is a marked increase in the rate of suicide following traumatic brain injuries. A widely publicized statistic that has gotten a lot of attention in the past few years is the estimate that there are close to 22 suicides per day committed by veterans and active duty personnel that are the direct result of PTSD, much of which is related to an experience that included a traumatic brain injury.
TBI is a significant life-changing event, much like cardiovascular disease, stroke and heart attack, all of which frequently lead to the onset of depression. Left untreated, depression can interfere with recovery and seriously decrease the quality of life.
It is important that anyone suffering a TBI is monitored for depression and, if diagnosed, treatment options are similar to those recommended for people with depression who are not dealing with a TBI. This may include anti-depressant medications, as well as behavioral therapy. Integrating the treatment for depression into the TBI treatment protocol will be essential for overall progress.