The Prevalence of Depression Following a Traumatic Brain Injury

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Depression is a common complication that occurs after a traumatic brain injury (TBI). Studies show that approximately 50% of individuals with a traumatic brain injury will experience depression in the first year, and nearly two-thirds of individuals with a traumatic brain injury will experience depression within seven years after the injury. Depression is a long-term complication that influences many aspects of life and can limit the ability to return to work, worsen cognitive function, and lead to dementia.  

Although there is a solid link between a traumatic brain injury and the development of depression post-injury, experts are not certain as to the mechanism that causes depression to be an increased risk in individuals with a traumatic brain injury; however, it is postulated that inflammatory changes in the brain play a role.

What is a traumatic brain injury?

A traumatic brain injury (TBI) can be caused by a forceful bump, blow, or jolt to the head or body or from an object that pierces the skull and enters the brain. Not all blows or jolts to the head result in a TBI. As many as 90% of TBIs are classified as concussions or mild TBIs. The vast majority of the time, symptoms of mild TBI will resolve within the first two weeks after the injury. For those people with a mild TBI that have symptoms unresolved for longer than three months, the individuals are diagnosed with post-concussive syndrome. 

Some types of TBI can cause temporary or short-term problems with normal brain function, including problems with how the person thinks, understands, moves, communicates, and acts. More serious TBI can lead to severe and permanent disability and even death.

What is the inflammatory hypothesis of depression?

After a number of studies and research, it is believed that inflammatory pathways associated with a traumatic brain injury may contribute to the development of depression. Chronic low-grade inflammation and the presence of inflammatory biomarkers in the cerebral spinal fluid (CSF). “There is now mounting evidence demonstrating that inflammatory pathways contribute to the pathophysiology of depressive disorders. As cytokine dysregulation is a hallmark pathology of TBI, the inflammatory theory of depression is particularly relevant to mood disorders that develop following a TBI”. 

What is depression?

Depression is a mood disorder defined by at least two weeks of feelings of sadness and other related symptoms that impede an individual from going about their daily life. The following are symptoms associated with depression: 

1. Feelings of sadness or hopelessness. 
2. Loss of interest or pleasure in usual activities. 
3. Feeling worthless, guilty, or that you are a failure. 
4. Changes in sleep or appetite. 
5. Difficulty concentrating. 
6. Social withdrawal 
7. Fatigue or lack of energy. 
8. Moving or speaking more slowly, or feeling restless or fidgety. 
9. Thoughts of death or suicide. 

Treating depression following a TBI and the path forward

Depression is often treated with psychotherapy in addition to antidepressants (as an add-on to psychotherapy); however, not everyone will benefit from this treatment protocol, especially individuals who develop depression after a traumatic brain injury. However, evidence is still consistent with selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for individuals with depression after a TBI. Understanding how cytokines and other inflammatory markers act in the development of depression following a TBI can lead to a treatment approach that targets these inflammatory markers. “As cytokine dysregulation is a hallmark pathology of TBI, the inflammatory theory of depression is particularly relevant to mood disorders that develop following a TBI. Determining how cytokines regulate mood is an exciting area of investigation and may have great potential for treating mood disorders in people that suffered a TBI”. 

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