Emotional Issues Associated with BI
Depression in Brain Injury
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Depression is quite common following brain injury. In some cases, it is caused by physical damage to the brain while in other cases it is an emotional reaction to injury and disability.
Depression may surface early or well after a brain injury occurs. Early symptoms of depression are often due to the physical effects of a brain injury, while symptoms that appear some time after an injury usually result from problems adjusting to the physical, social and vocational consequences of injury.
Medications can correct problems with brain chemistry and have proven very helpful for persons who have depression caused by physical damage to the brain. Most current medications are safe and effective, but usually some trial and error is needed to find what works best. Since persons with brain injury often take several other medications, coordination between all healthcare providers and the physician prescribing antidepressant drugs is important.
When the depression is an emotional reaction to injury or disability, medication can also be helpful, but in these cases, counseling is almost always necessary. Most often, counseling can lead to changes in lifestyle and self-perception that reduce depression and increase functional skills. Counseling requires time and effort, but the results can be rewarding, not only in reducing depression but also in establishing a general strategy for dealing with recovery.
When family members see symptoms of depression, they should keep a written of record of symptoms. A symptom record helps in diagnosing depression (which is often goes unrecognized) and is an important tool when consulting with physicians about treatment options. Early diagnosis and treatment can prevent psychological pain and distress associated with depression and can improve the life satisfaction of persons with brain injury.
Finding the right counselor for a person with brain injury can be challenging. Many different health care specialists offer counseling services. A healthcare professional who knows the person and has contributed positively to their recovery, may be a good resource for a referral. The specific professional discipline of the counselor is not as important as the professional’s experience in counseling the person. Five questions to ask when looking for a counselor are:
- Does the counselor have the appropriate skills? For instance if behavioral issues are the problem, a counselor specializing in family therapy may not be the best choice.
- Over the past five years, how many brain injured persons did the counselor see with similar problems?
- Can the counselor provide information on how effective treatment has been? For example, has treatment helped other brain injured persons to achieve a desired goal such as living independently, or preparing for return to work or school?
- Do the counselor and brain injured person work well together?
- If the counselor is not a M.D., is he or she willing to consult with the doctor of the person with brain injury to evaluate and monitor the effectiveness of medication?
Stephen N. Macciocchi is Director of Neuropsychology at Shepherd Center and an Adjunct Associate Professor of Rehabilitation Medicine at Emory University School of Medicine. Dr. Macciocchi is a member of the editorial boards of Rehabilitation Psychology, Brain Injury and the Journal of Head Trauma Rehabilitation. He currently serves on the American Psychological Association Clinical Neuropsychology Ethics Committee. Dr. Macciocchi is Director of the APPCN Postdoctoral Clinical Neuropsychology Fellowship at Shepherd Center, and he has authored and co-authored numerous articles and book chapters on brain injury.