Synapse - reconnecting lives

Depression is a common experience following a brain injury. 

Depression is a mood state, during which a person may feel 'low,' 'down,' 'negative' and generally unhappy about themselves, the world and their future. In most cases, depression is a reaction to difficult circumstances, such as a traumatic brain injury (TBI) or other type of brain disorder.

Apart from negative thoughts and emotions, common signs can include:

• reduced attention to physical appearance
• withdrawal & loss of interest in formerly enjoyed activities
• sleep disturbance, appetite changes and tiredness.

• a gradual decline in ability to perform everyday tasks
• decline in ability to cope with every day stressors
• increased irritability, anger, frustration and agitation. 

Some of these are common effects of a brain injury, so it can be hard to pinpoint depression as the cause. It is important that family and friends are aware of the symptoms of depression as 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.

Possible causes of depression

Depression can occur at any stage following an acquired brain injury, from the acute hospital stage to many years post-injury. In the early stages of recovery it can be a sign the person is developing awareness of their brain injury's effect - a promising sign for the rehabilitation process as the person can identify and work on areas needing attention.

Depression following a TBI or similar brain disorder is also related to other factors including:

• Social isolation
• Sleep difficulties
• Difficulties in maintaining employment and relationships
• Injury to the parts of the brain responsible for emotions
• History of mental illness or substance abuse 
• Some medications can increase the symptoms of depression.

Diagnosis of clinical depression

Professional help and treatment is advisable when depression becomes a serious problem. Ensure you see your GP for a referral to specialists if you suspect you or your loved one has clinical depression. The earlier it is diagnosed; often the easier it is to treat (see our fact sheet on clinical depression). 

Coping strategies for depression

• Adequate sleep
• Listen to music
• Socialize with friends
• Avoid alcohol and other drugs
• Work on a personal project or hobby
• Walking or other exercise
• Scheduling activities and making short-term plans
• Each a healthy diet
• Write in a diary daily five things you are grateful for
• Use positive self-talk - 'I can cope, I can manage this'.

Thought-challenging

This useful technique involves replacing upsetting thoughts with constructive explanations or more rational thoughts. You can keep a diary to monitor and assess your negative thoughts - this can 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.

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.

How friends & family can help

• Take time to listen and ask questions
• Don't minimize the issue e.g. don't say "Get over it" or "It's not that bad"
• Help to schedule in activities for each day
• Reinforce any positive coping skills e.g. talking, exercising etc.
• Give encouragement after any tasks are completed
• Encourage them to seek help from a counsellor or psychologist.

Suicide risk

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 doctor or psychologist. Warning signs to look for include:

• Statements like "It would have been better if I had died"
• Making threats about committing suicide
• Suddenly becoming cheerful after a long period of depression (this can indicate a decision to use suicide as a solution)
• Having a plan for suicide, and the means to achieve it are very strong warning signs and must be taken very 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.