Depression after ConcussionHas Many Elements
- Organic Injury to that Part of the Brain
- Poor Information Processing
- Reactive Depression – Life is Falling Apart
- Depression Has Cycles
Perhaps one of the most significant reasons that depression after concussion is such an important symptom with the subtle brain injury is that denial, which is a major symptom of severe brain injury, is not a major factor with these injuries. Most people whose deficits flow from concussion including depression after concussion, are keenly aware of the differences in their abilities. While current memory is compromised, they have no problem remembering what their life was like premorbid. Anyone suffering a major loss, will experience some adjustment problems. When that loss is the essence of what made you special, the adjustment problems are naturally expected to be substantial.
What makes the adjustment so difficult, is that the brain which is responsible for making the adjustment, is working less efficiently than before. When bad things happen in our lives, it is our brain that must digest the impact, find ways to reconstruct an optimistic framework and adjust our future actions and expectations to the new situation. When an injured brain tries to do this, it does so less efficiently, and often lacks the insight to do so uniformly. The injured brain may obsess on one aspect of the adjustment process and never see the overall picture of how adjustment could occur.
More difficult to explain, but clearly a factor is that the focal part of the brain responsible for controlling mood and depression after concussion may have been injured, and not working properly.
Another aspect of the adjustment to the adversity of brain injury, is that the period right after injury, may not be the darkest hour. As with many other injuries, the initial rehabilitation period, when progress can be seen, and full recovery is still expected, can be a very optimistic time. Some people may even feel stimulated by the process of trying to make themselves better. The danger time may come later, when the realization hits that the best efforts have fallen short of completely restoring pre-injury function. The existential realization, that this is all that is left of me, can be the hardest thing to deal with. That point in time when the realization hits that it is never going to be the same, is the hardest and most dangerous time.