Brain injuries are complex medical conditions that can have profound and long-lasting effects on an individual’s mental health and well-being. These injuries often lead to symptoms that can be mysterious, confusing, and tormenting, as they can be difficult to diagnose and manage. The impact of brain injury on mental health is widely under appreciated.
It has been reported that around 1 in 5 individuals experience mental health symptoms after mild traumatic brain injury (mTBI) (Stein et al., 2019). Furthermore, it has been demonstrated that individuals who undergo mild brain injury are at increased risk for both PTSD and major depressive disorder (Stein et al., 2019). While it can be easy to appreciate how serious impacts to the head can lead to changes in psychological function, it should be emphasized that even the mildest of brain injuries, under certain conditions, can lead to persistent mental health challenges (McInnes et al., 2017). To fully appreciate this point, it is probably helpful to briefly review the nature and types of brain injuries.
Types of Brain Injuries and Their Causes
Brain injuries can be broadly categorized into traumatic brain injuries (TBI) and acquired brain injuries (ABI).
Traumatic Brain Injury (TBI): This occurs when an external force, such as a blow to the head, causes brain dysfunction. Examples include concussions from sports injuries, head trauma from falls, and motor vehicle accidents.
Acquired Brain Injury (ABI): Unlike TBI, ABI results from internal factors, such as a lack of oxygen (anoxic brain injury), stroke, or infections and exposures, such as Lyme disease, COVID-19, cytomegalovirus (CMV), and even mold exposure, can also contribute to brain injury (Ehsanifar et al., 2023; Mayer et al., 2020).
Even mild brain injuries, such as concussions, can have lasting effects. Persistent symptoms like fatigue, headaches, and cognitive difficulties are common, and research has shown that these issues can endure for months or years after the initial injury (McCrory et al., 2017).
Brain injuries caused by infections and chronic illnesses are less recognized but equally impactful. For example, neuroinflammation caused by chronic viral infections can lead to cognitive and emotional dysfunction (Miskowiak et al., 2021). Similarly, post-viral syndromes, such as those associated with long COVID, often mimic brain injury symptoms, including memory deficits and mood changes (Taquet et al., 2021). Pre-existing or overlapping illness can serve to amplify a traumatic brain injury.
Personality Changes After Brain Injury
Personality changes are a common but often overlooked consequence of brain injury. Damage to specific brain regions, such as the frontal lobe, can lead to alterations in behavior, mood, and emotional regulation. Individuals may become more impulsive, irritable, or apathetic, which can strain personal relationships and impact their quality of life (Rosenberg et al., 2014). Recognizing these changes as symptoms of brain injury, rather than personal failings, is critical for effective intervention and support.
Depression After Brain Injury
Depression is one of the most common mental health conditions following a brain injury. Epidemiological studies indicate that up to 50% of individuals with TBI experience depression within the first year of their injury (Hoffman et al., 2019). This depression can manifest as persistent sadness, loss of interest in activities, sleep disturbances, and feelings of worthlessness. Left untreated, depression can exacerbate cognitive impairments and hinder recovery.
Psychiatric Diagnoses Aggravated or Caused by Brain Injury
Brain injuries are associated with a range of psychiatric conditions, which may arise as a direct result of the injury or be exacerbated by it.
Post-Traumatic Stress Disorder (PTSD): Many individuals with TBI also experience PTSD, particularly if the injury resulted from a traumatic event such as a car accident or assault. The coexistence of TBI and PTSD can complicate recovery, as both conditions share overlapping symptoms like irritability and concentration difficulties (Warden, 2006).
Cognitive Impairments: Memory problems, attention deficits, and executive dysfunction are common after TBI and can significantly impact daily life (McCrory et al., 2017).
Chronic Pain: Persistent pain conditions, including headaches and musculoskeletal pain, frequently accompany brain injuries. These chronic pain syndromes can lead to further disability and contribute to depression and anxiety (Kreutzer et al., 2009).
Neurodegenerative Diseases: Evidence suggests that TBI may increase the risk of developing neurodegenerative conditions like Alzheimer’s disease and Parkinson’s disease. The mechanisms underlying this association likely involve chronic inflammation and abnormal protein aggregation in the brain (Gardner et al., 2015).
Reassurance and Hope in Medical Advancement
While the symptoms of brain injury can be perplexing and distressing, it is important to remember that they are often explainable through a thorough neurological assessment. Advances in brain imaging, diagnostic tools, and integrative assessment methods, have made it more possible to pinpoint areas of injury (previously "invisible" to conventional diagnostic approaches) and tailor treatment strategies accordingly.
Furthermore, increasing awareness and appropriate training by healthcare providers in the diagnosis and treatment of the neuropsychiatric consequences of brain injury are giving hope and avenues for treatment to a population of people that might have otherwise gone undiagnosed and untreated for years.
If you are an individual suffering from "mystery" symptoms, affecting mood, memory, concentration, personality, sensory function, balance, and energy levels, it may be worth reviewing your past with the goal of potentially identifying "little knocks to the head" and/or periods of prolonged illness, and/or intense emotional stress. According to a growing body of evidence, these factors can often overlap, causing silent injuries to the brain that can cause challenging, chronic symptoms. If all of this "rings a bell", then an integrative, neuro-psychiatric assessment, and rehabilitation program, might be a good next step.
About the Author
Dr. David George is a multiple, board-certified clinician and clinical researcher based in Scottsdale, Arizona. His clinic, Neuregen, an integrative psychiatry and neurological health center specializing in the intersection of brain function and mental health (psychiatry), offers integrative, recovery programs, utilizing therapies such as ketamine therapy, stellate ganglion block, neurorehabilitation, physiotherapy, psychotherapy, and integrative psychiatry, intended to address all dimensions of polytrauma. Dr. George and his team at Neuregen are dedicated to helping individuals "put themselves back together again" by navigating the challenges of brain injury with compassion and expertise.
References
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