Study Sheds Light on Prevalence, Impacts & Treatment Challenges Related to Depression in Traumatic Brain Injury (TBI) Patients

Depression is commonly a complication of traumatic brain injury. In fact, within the first year of sustaining a TBI, at least one in every three people with a moderate to severe TBI will experience at least one episode of post-traumatic depression (PTD). Despite its documented prevalence, PTD remains severely undertreated.

Looking to shed more light on these treatment challenges, a recent “narrative literature review”¹ focused on summarizing “the prevalence and impact of PTD among those with moderate to severe TBI and to discuss current challenges in its management.” The following presents the major findings and insights uncovered by that review.

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Symptoms & Impacts of PTD on TBI Survivors Uncover Treatment Challenges

Depression & TBI: The Prevalence, Impacts & Challenges

Interestingly, depression in TBI patients may not present the same way as it would in the general public. In fact, the study reported that the following symptoms are far more likely to be present in TBI survivors with PTD:

• Irritability
• Anger
• Aggression
• Self-criticism
• Guilt.

Sadness and tearfulness were far less common in TBI patients with PTD.

For TBI patients living with PTD, this review explained just how profound the impacts can be. Specifically, it noted that “PTD has implications for:

1. Health, including higher re-hospitalization rates, greater suicide risk, and more caregiver burden
2. Participation, including returning to work or school and social relationships
3. Quality of life, including life satisfaction and overall wellbeing.”

The Prevalence & Risk Factors for PTD Uncovered

While the impacts of PTD can be far-reaching, so too can be the incidence of the condition itself in TBI patients. In fact, between 30 and 50 percent of those with moderate to severe TBI will experience “an episode of PTD in the first year after injury.”

The study noted that post-traumatic depression can arise from a range of complicated factors, like:

• Biological factors caused by the injury, such as inflammation
• Psychological factors, which may arise from “pre-injury personal characteristics” and/or adjusting to new physical or cognitive disabilities caused by the TBI
• Post-injury life-style habits, with those using alcohol and/or drugs being more prone to depression.

TBI patients with the highest risk of developing PTD can include (but may not be limited to) those who experience:

• Certain neurobiological changes as a result of the injury
• Major life stressors during the TBI recovery process, which could include unemployment or limited financial resources to cover treatment costs
• Substance abuse before or at the time of injury.

The multiple possible causes, which may be present simultaneously, coupled with the nature of the injury and the individual’s lifestyle choices, mean that there is no one-size-fits-all remedy or treatment plan that can work for PTD.

That is the main reason that treating PTD is so difficult and often poorly done (when compared to Major Depressive Disorder) – and why so many cases of PTD go untreated.

Recommendations for Improving PTD Treatment for TBI Survivors

The study highlighted the fact that current literature does not reflect any best practice in the treatment of PTD. However, medication (Serotonergic drugs) and cognitive behavioral therapy have both proven to be effective.

Selective Serotonin Reuptake Inhibitors (SSRIs), which are effective in treating other depressive disorders, have proven largely ineffective in treating PTD in TBI patients with extensive inflammation.

Consequently, the study recommends that clinicians take a more individualized approach and consider the patients’ past mental-health history, adjustment-based causes, biological causes, and the interplay with other medications. The study concluded:

Overall, no single PTD treatment is likely to be universally effective and, therefore, personalized approaches to the research and management of PTD are necessary.   

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1: A narrative literature review of depression following traumatic brain injury: prevalence, impact, and management challenges, published online June 2017