In episode 320, I received a question from a listener who has been struggling with severe depression after being in a car accident that resulted in a concussion. In this post, I dive into the details and outline some options to help you move forward.
Hello Duff the Psych, I was in a car accident 3 months ago that resulted in a concussion. My physical symptoms such as: headaches, nausea, dizziness etc have gone away. However, I have been experiencing severe depression. The concussion specialist said that depression symptoms should not be getting worse, especially as normal activities resume. My therapist (an ND) does think the depression is still a symptom from the concussion. I have struggled with depression and anxiety in the past but have been able to manage it with therapy, additional supplements and meditation. These tools don’t seem to be helping lift the “dark cloud,” like they use to and as my depression has gotten worse my “normal activities” have gotten much harder. I feel like I’m at a breaking point and need to try antidepressants. Do you have any insight on how concussions relate to depression and if antidepressants are typically used in treatment? Thank you.
Thanks for the question. First off, I’m glad that you made it through the car accident alive. That must have been a really scary experience.
I wanted to just clarify some terminology here. A concussion is actually what we would call a mild traumatic brain injury or MTBI. A concussion is a mild injury to the brain caused either by a blow to the head or from the head shaking violently. You mentioned a lot of the common symptoms in your question. Headaches, nausea, dizziness, sensory sensitivity, agitation, etc. Not fun. Typically, there is no lasting effect after healing from a single concussion, though that definitely varies. There does seem to be an additive effect though from multiple concussions, which is where you get chronic traumatic encephalopathy in athletes. I’m glad to hear that a lot of your physiological symptoms have resolved. Now we have the depression left to cope with
Depression is extremely common in MTBI. There can be multiple factors that contribute to this. It is understood that the damage to the brain can impact the functioning of neurotransmitters in the brain, which can contribute to depression symptoms. There’s also obviously the possibility of sadness and depression due to the injury itself. It sucks to have a concussion. It probably interfered with your life. It has made things difficult for you, which is sad. Totally reasonable to have reactionary depression due to what happened to you.
When it comes to depression symptoms getting worse, I wouldn’t totally agree with what the concussion specialist said in your case. I think they probably meant that at this point, your brain is mostly physically recovered from the brain injury. You have healed to the point that your physical symptoms are starting to resolve. So the chemical and neurological side of things should be getting better. But that doesn’t mean that your depression is going to necessarily improve at the same rate. Your depression could very well be multi-factorial as I mentioned. I also don’t know the circumstances surrounding the accident. Was the accident just one more thing in a string of events that were leading to your depression? Was depression already somehow related to the reason for the accident? Just some things to consider. In all likelihood, this episode of depression will lift over time, but you could definitely use a little bit more help here.
I’m glad that you’re in therapy. It sounds like you’ve built a great toolbox of coping skills for yourself. But at this time, the tools that you have aren’t quite enough because this accident has pushed you past your coping threshold. If I had to guess, the depression could be gone within a year. But you also don’t need to leave it to chance as much. One thing that is a potential risk is that the changes to your motivation, choices that you make while depressed, and other structural changes could impact your life in a way that actually ends up contributing to depression or driving you deeper. We don’t want that kind of unfortunate cycle.
I think that it is totally reasonable to use antidepressant medication in a situation like this. SSRIs are the most commonly used and most helpful medications for mild traumatic brain injuries. Definitely speak with your doctor about medication choices because there are some types of medications such as tricyclic antidepressants that are contraindicated. Not only do SSRIs help with depression, but research also indicates that they can help with other aspects of recovery from brain injury, such as some physical symptoms. In a situation like this, you may not even need to take them for a very long time. Many people go on SSRIs for a period of time while they are recovering and then taper off them when they feel more stable. Don’t forget that you are doing nothing wrong by having a bit of a struggle here. You don’t need to just tough it out. I would say don’t skimp on whatever you need to do to help yourself. You won’t regret it.
You can listen to this on Episode 320 of the podcast!
Thank you for the great question!
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