TBI Depression and PTSD

What is Depression?

Depression is a feeling of sadness, despair or hopelessness that does not get better over time. It typically is so consuming it interferes with daily life. Everyone has their ups and downs. That is not what this is. Depression goes beyond feeling a little blue for a few days.

Symptoms of Depression

There is cause for concern when feeling depressed or losing interest in usual activities occurs at least several days per week and lasts for more than two weeks. Symptoms include:

1. Feeling down, sad, or hopeless.

2. Loss of interest in usual activities.

3. Feeling worthless, guilty, or that you are a failure.

4. Changes in sleep or appetite.

5. Difficulty concentrating.

6. Withdrawal from others and daily life.

7. Tiredness, fatigue, often with inability to sleep soundly.

8. Moving or speaking more slowly,

9. Feeling restless or fidgety.

10. Thoughts of death or suicide.

What is Post Traumatic Stress Disorder (PTSD)?

Consider PTSD to be depression on steroids, as if depression alone is not enough. Most people with PTSD incurred a traumatic event or experience that leads to mental and physical symptoms. These can be debilitating.

Symptoms of PTSD

The following symptoms, lasting a month or more, means it is time to seek out help:

1. Reliving the experience. This may include: nightmares, flashbacks, and feeling horrible when reminded of the experience.

2. Avoidance. Steering clear of people or places that are a reminder of the trauma. This can include any place that makes the PTSD sufferer feel unsafe, that feeling itself can be a trigger. Almost seven years later I still struggle to cross the actual intersection where I incurred a TBI.

3. Detachment from others.

4. Sadness, loss of interest in things.

5. Persistent negative thoughts / feelings similar to depression.

6. Memory loss (not specific to the brain injury), inability to remember the event well which may bleed into general memory challenges.

7. Self-blame.

8. Changes in activity or arousal.

9. Taking risks, acting disruptive.

10. Insomnia.

11. Self-destructive behavior, anger, irritableness.

12. Inability to concentrate.

13. Anxiety or feeling jumpy.

14. Turning to drugs or alcohol.

What does TBI have to do with Depression and PTSD?

About half of all people with TBI experience depression in the first year after injury. Nearly two-thirds are affected within seven years post injury. This compares to about 10 percent of the general population. Those are some pretty shocking statistics.

I think I am suffering from Depression or PTSD after a TBI. What can I do now?

Get medical help! Depression and PTSD are not signs of weakness but very real medical conditions that are treatable. Sometimes we all need help and that is okay! I am not medically trained and I can simply share my experiences, research and what helped me.

Your doctor is a great starting place. There are many trained professionals capable of diagnosing and directing you appropriately including social workers, therapists or nurses. Medications may be required along with counseling and therapies. Both have their place, along with exercise and meditation.

Common medications:

There are different types or classes of antidepressants. Studies of depression linked to TBI have found that some classes may work better than others (SSRIs such as sertraline and citalopram and SNRIs such as venlafaxine). Some should be avoided since they may have side effects than can aggravate TBI symptoms or delay recovery (MAOIs or monoamine oxidase inhibitors and TCAs or tricyclic antidepressants). Your doctor may suggest looking into medical marijuana (I’ll discuss this more in a later chapter). Each case is unique, and there may be additional reasons to consider any of these. Consult your doctor for more information and there are some resources at the end of this chapter. I found some great support groups online well into my recovery that I wish I had access to earlier.

Common therapy treatment:

Cognitive processing therapy (CPT) or Cognitive Behaviour Therapy (CBT) is designed to replace negative thoughts with positive thoughts and actions. For PTSD specifically, therapists may introduce Prolonged Exposure Therapy or Eye Movement Desensitization and Reprocessing therapy (EMDR). The latter two are designed to enable acknowledging the trauma and helping the recoveree to not be triggered by the event.

Be Open to Other Ideas:

Don’t underestimate the value of exercise and being out in nature as well! As you are able to tolerate movement, it is important for your physical and mental health. You can also explore acupuncture and biofeedback. Another area with growing evidence to support is something called EFT (Emotional Freedom Technique) and tapping. Find what works for you! I explored a lot of modalities off the beaten path.

“If you do what you’ve always done, you’ll get what you’ve always gotten.” – Henry Ford

What helps me?

Being ‘stuck’ by yourself for so much time with no distractions and only your own thoughts to keep you company, is a lot easier to tolerate if you genuinely like yourself and when those thoughts are positive ones! I had to have the courage to start listening to my body and to ignore the current medical advice of do nothing. This started a practice of daily walks, short at first. Next, I purchased a dollar store bird feeder and seed. Watching the birds coming and going created a sense of calm and a connection with nature.

After months of isolation, little to no family support and little to no successful medical support, a book gifted to me a decade earlier floated to the top of my ‘read me’ pile (You Can Heal Your Life, by Louise Hay). I picked it up and started working through the exercises page by page. The most important takeaway I learned was to start each day with a series of positive daily affirmations and an expression of love to myself. Looking directly into the mirror, I repeated “I love and approve of myself.”

Around this time, I went to see a BodyTalk and Reiki energy work practitioner. This may not be for everyone but it really resonated with me. I truly do believe we are all energy and energy surrounds and connects us all. I think we can all relate to an experience of walking in a room where a couple has recently been fighting. You can sense the tension in the air. The more I started embracing these concepts, the more quantum physics peaked my interest and I started reading and watching videos on that. This same practitioner further recommended I look into EFT (Emotional Freedom Technique) Tapping and a book The Biology of Belief by Bruce Lipton. The latter was a tough read but the contents appealed to my logical mind and helped me be open to non-traditional therapies. This was a turning point in my recovery.

Out of these combined events I developed a daily morning and evening routine. When my routine slips I find I regress in some of my post concussive symptoms, even now seven years later.

My morning routine:

1. Start every day with a series of positive affirmations before even leaving bed! Some examples:

• I am worthy

• I am loved

• I am safe

• I am improving every day

• I am strong

• I am healthy

2. Drink a glass of water. Thank the water for nourishing me.

3. Meditate for 10 minutes

4. Go for a walk (this is my four-legged companion’s idea, not mine)

5. Yoga (10, 20 or 30 minutes).

I sometimes change the order of the last three.

My evening routine:

1. Go for a walk (again, my four-legged companion insisted)

2. Turn off all electronics 2 hours before bed time.

3. Dim the lights (I actually switched all lamp bulbs to tinted incandescent blue or green for evening wind down in the early days. I have since gone with regular incandescent).

4. Engage in light conversation. Talk about my day with my daughter or a friend.

5. EFT Tapping for 5 – 10 minutes.

6. Mediate for 10 minutes.

7. Turn in

8. Listen to music or try to read. There are some great free resources online to help sleep .

9. Think of at least one thing I am grateful for. Today I was grateful for indoor plumbing, the feeling of the sun on my face on my lunch break and that my daughter is recovering from an illness.

Tips and Tricks During the Dark Days

1. Have regular medical check-ins. Be open to medications and therapy.

2. Get an advocate if you don’t have one. Let him or her know how you are feeling. They can help you find resources.

3. Break night-time negative thought patterns. If you are having recurring nightmares or keep slipping back into the same negative thoughts each time your head hits the pillow, get up! Do something! It’s okay to get up in the middle of the night, have a decaf tea, watch a sitcom (if you can tolerate it) or play an idle ‘online game’ with minimal movement. I play a farming game myself or a card game where the screen doesn’t move. You need to break the negative cycle so you can return to restful sleep.

4. Take a technology break. Get off all screen-based technology with a caveat… (see number 5).

5. Find local support groups. An in person one is ideal, but online works too. Be careful and limit your screen time.

6. Get out in nature! Even sitting in a garden or out a window at nature is great way to calm your mind.

7. Move when you’re ready. This may be simple seated yoga or short walks. Exercise is a natural anti-depressant.

8. Avoid stress and negativity. This includes television (limit your intake of news, murder mysteries, drama).

9. Consider an assessment with a neuro-psychologist.

Chapter Assignment

Put a morning practice and evening practice in place.

Let’s start a journal together! This can be a note book purchased at a dollar store. Write down positive daily affirmations that you can repeat to yourself each morning before you start your day.

At the end of each day, turn off the technology and bright overhead lights and enter in your journal one thing you are grateful for. If you have more than one thing, write that down too!

Need a bigger challenge? Struggling to be grateful or start affirmations? Stand in front of a mirror. Look deeply into your eyes and repeat “I love and approve of myself.” Say it at least 10 times. If you don’t believe it, do it again.

For the Non-TBI Reader. What TBI / Concussion survivors are going through.

Shortly after I incurred a severe concussion in 2014, I was ordered to do absolutely nothing by medical experts. I was unable to work or go on a computer or watch television. I was unable to be the mother my teen daughter needed and deserved. Being highly independent and used to working in a high demand career, teaching part time, volunteering and as a single mother, this loss of self was devastating. Despair at the thought of losing my home and ability to provide for my daughter further compounded this strain. Complete and utter despair and hopelessness set in.

Think about your own life and the small things you may take for granted. Things like cooking a meal, cleaning house, driving to the store, or going to work. You’ll never know what you may miss until you are unable to do it. Concussion and TBI survivors may be struggling with physical injuries in addition to mental impairments directly attributed to brain trauma.

Some of these physical injuries can impair a persons’ ability to drive or even to walk a straight line. I suffered balance issues in the early days, blurred and double vision. Through some of my therapy providers I learned of cases and met many patients who shared these afflictions. Simple tasks such as cleaning the house were impossible for me. The act of deftly moving around furniture to dust of vacuum was insurmountable! I would stumble and fall risking further concussion. I was physically unable to unload a dishwasher. My hands would frequently spasm and I would drop plates. Watching television, particularly action-based shows would make me nauseous, dizzy and aggravate the persistent headaches.

For me this meant a lot of alone time. I never knew when I could tolerate a conversation. Friends and family simply slipped away since they could not appreciate the physical and mental challenges I was facing. In fact, many would get angry that I was not reaching out. To the rest of the world, I looked fine. I was anything but fine.

In addition to a complete loss of sense of self, loss of independence, a lot of friends and family seem to disappear from a recoveree’s life. Do realize that a lot of this is at the perception of the recoveree. In their dark little world, with nothing to do, and with impaired thought processing and short-term memory issues they truly are all alone even IF you are right there!

I have a friend who suffered a concussion a couple of years before myself. There are occasions I would visit, particularly right after a medical procedure to help out or just to keep her company. Recovered now, we have talked about our experiences. She truly forgets these visits! I know I did the same with the few people who remained by my side.

I Am a Support Person. How Can I Help?

1. Don’t judge. Mental illness is a real struggle and it is an illness. Gently encourage the TBI survivor to seek medical assistance.

2. Help get medical assistance.

3. Limit stress.

4. Check in on your TBI recoveree often! It helps to know people care. Survivors really do have memory lapses and may forget you visited.

5. Don’t take survivor anger directed at you personally. TBI survivors may be quick to anger or lash out. This is a frustrating time for survivors and it is not intentional.

6. Take a break yourself! These are tough times for everyone.

7. Never say “Just get over it.”

My Story

About five years into my recovery I picked up writing to continue my healing and work on word-finding and communication skills that I felt had not recovered. This was likely my toughest story to write and share. This section of this chapter was even harder still. I grew up in an age where mental health and depression wasn’t discussed. I’ve had frank conversations with each of my parents over the years about friends or family members who are struggling with depression or anxiety. They were incapable of understanding why someone doesn’t just shake it off. I’m not capable of having conversations on this topic to gently explain the desolation, likelihood of chemical and physical imbalances playing a part. I was not capable post-concussion, nor did I have an appreciation for it myself until experiencing it first-hand.

Additional posts and stories for more information

A TBI story, Green Doesn’t Always Mean Go

Identifying and Coping with TBI, The Early Days

A TBI Story, The Long Winter of Depression

TBI Healing Modalities and Treatments

A few Sources and Resources

There is a lot of great information available online and more information is coming out regularly on TBI, concussion and related conditions including depression. The acceptance, available treatments and body of knowledge around concussion, TBI and brain encephalopathy is growing every day. Each person’s experience and recovery is unique and there is not a single solution or path to help everyone.

Some great online resources include:

https://msktc.org/tbi/factsheets/depression-after-traumatic-brain-injury

http://www.nimh.nih.gov/health/topics/depression/index.shtml

https://thetappingsolution.com/eft-practitioners/

https://www.bodytalksystem.com/

Books that helped me:

The Biology of Belief by Bruce Lipton

You Can Heal Your Life by Louise Hay