Mental Health After TBI or Concussion: Recovery Is Possible
Mild or severe traumatic brain injury (concussion and TBI) can cause upsetting changes to your mental health. Brain injury can worsen pre-existing mental illness or cause new symptoms — such as anxiety, depression, mood swings, anger, post-traumatic stress disorder (PTSD), and more. Don’t give up hope: There are good treatment programs that can help you recover.
83% of the patients we see at our post-concussion treatment clinic report changes in mood or personality after their injury. Many of them describe similar post-injury frustrations and feelings, such as:
“Am I a bad parent because I don’t have positive feelings for my kids anymore?”
“I can’t control my temper. One wrong word and I just lose it.”
“I don’t have any hope for the future. I feel like I’ll never be myself again.”
“One time I dropped a dish and it shattered. I stared at it but I couldn’t bring myself to do anything, so I went back to bed and cried.”
It’s heartbreaking. Many patients feel guilty for the way they act and feel. They don’t understand why they’re thinking and saying the things they do. Many of them, like attorney Anthony Loubet, were never warned by their doctors that their mental health could change drastically after their brain injury.
While previous mental health struggles are risk factors for post-injury mental illness, you don’t have to have had emotional symptoms before your injury to develop them after.
Mental health changes after brain injury are extremely common: you aren’t crazy and shouldn’t blame yourself for emotional turbulence. Neurorehabilitation, combined with cognitive behavioral therapy or another form of talk therapy if needed, can significantly improve your post-injury mental health. The key is to treat the brain injury first, then focus on any persistent mental difficulties. Treating the root cause makes it much easier to overcome these problems with continued therapy and healthy habits at home.
To help you understand what’s happening in your brain and how to start your recovery journey, we explain...
- What causes mental illness after TBI
- What types of mental health struggles you might face after TBI
- Available treatment options for emotional and mental changes after TBI
Note: Over 80% of our patients have experienced emotional symptoms after a concussion. Many of those symptoms resolve shortly after treatment at our clinic (although some mental health disorders such as depression and anxiety can take additional therapy to resolve). On average, our patients report an over 50% improvement in emotional symptoms after just one week of treatment. If you’d like to learn more about how we can help you, book a consultation.
What Causes Mental Illness After Traumatic Brain Injury?
Traumatic brain injury can cause temporary or long-lasting mental illness or emotional symptoms. Often, these symptoms result from a combination of post-injury dysfunction in the way the brain communicates, post-injury stress on the autonomic nervous system, and the brain’s natural reaction to physical and emotional trauma.
Mental illnesses are conditions that affect a person’s thinking, feeling, mood or behavior, such as depression, anxiety, bipolar disorder, or schizophrenia. Such conditions may be occasional or long-lasting (chronic) and affect someone’s ability to relate to others and function each day. (Centers for Disease Control and Prevention at CDC.gov)
So how does a head injury change how you feel and think? It starts with the physiological changes caused by brain injury. At the most basic level, even a mild traumatic brain injury can disrupt the relationship between neurons and the blood vessels that supply them with the right amount of nutrients at the right time, a process known as neurovascular coupling.
Dysfunctional neurovascular coupling results in hypoactive brain regions (areas that don’t do their fair share of the work). Surrounding regions might try to take on that work, but they can’t do it as efficiently. Overall, this dynamic exhausts the brain far more quickly than healthy functioning.
But this dysfunction isn’t structural. Think of it like looking through the window of a business. The building’s intact, everyone has computers, and all the employees seem busy. All the physical components you need for the business are present, just like your brain is physically intact (unless you suffered structural brain damage from a severe TBI).
But just because all the parts are there doesn’t mean they are working well together. That business could be failing because the software they use is buggy or the employees don’t do their work on time. In a similar way, the brain can look fine on the outside but struggle to function correctly long after your initial injury.
These changes in your brain following injury can contribute directly to mental health issues. However, some of your emotional symptoms may be secondary, e.g., caused by some of the other symptoms of a concussion. Some concussion symptoms that may affect your mental health include:
- Sensory sensitivity (to light, noise, crowds, and so forth)
- Feeling overwhelmed (which happens because your brain simply can’t process everything it used to before your injury)
- Sleep problems (including poor sleep quality, trouble falling asleep, sleep apnea, and more)
- Cognitive impairment (such as difficulty following conversations, poor executive function, struggling to pay attention, worse short-term memory, difficulty with word-finding, and brain fog — all persistent symptoms that are very frustrating to experience)
- Hormone dysregulation
In addition, any TBI, mild or not, can affect your autonomic nervous system (ANS). The autonomic nervous system reaches throughout the body into every organ system. It’s responsible for many automatic processes — like your heart rate and breathing — and controls your “fight or flight” and “rest and digest” response.
After a concussion, your ANS may become skewed toward “fight or flight.” When that happens, it can also contribute to certain mental health problems such as anxiety and PTSD.
To recap, mental health struggles after a head injury are often neuropsychological, a combination of physical and emotional factors, including:
- Physiological changes in your brain.
- Your brain’s natural reaction to trauma.
- Symptoms such as poor sleep that exacerbate mental symptoms.
- Dysregulation of your autonomic nervous system.
What Mental Health Struggles Can a Concussion or Severe TBI Cause?
The highest prevalence mental health struggles caused by a brain injury include depression, anxiety, PTSD, and a slew of emotional changes (which patients and their family often refer to as personality changes).
If you suffered from any of these emotional symptoms or mental illnesses before your injury, you have an increased risk of them coming back or worsening after the injury. Patients with a history of psychiatric disorders often need a combination of talk therapy and treatment for their acquired brain injury in order to make the best recovery.
If you haven’t suffered from any of these issues before, you might make a faster recovery than if they were pre-existing issues, but each person’s recovery journey is different. Taking longer to heal does not mean that there is something especially wrong with you.
Patients with a depressive disorder before injury have a higher risk of worse depressive symptoms after the injury. Here are a few of the ways post-concussion depressive symptoms can present:
- A negative feeling that goes beyond normal sadness (it might feel a bit like grief, but you recognize it as being distinct from grief)
- Low or no motivation, such that your ability to do what you need or want is compromised
- The inability to feel pleasure (anhedonia)
- A persistent disinterest in things (apathy)
- Feeling of emotional heaviness or like you’re moving through mud
- Feeling empty or robotic
- A negative outlook about yourself, the world, and/or the future
- A sense of worthlessness
- Suicidal ideation
To learn more about why patients experience depression after a brain injury and how it’s treated by by neuropsychiatric health professionals, read our patient’s guide to post-concussion depression.
Note: If you are experiencing suicidal thoughts, please seek help from a qualified mental health care provider. You matter, and you can get better. In emergencies, call the National Suicide Prevention Hotline at 1-800-273-8255.
There is more than one kind of anxiety after a head injury. You may experience situational anxiety (for example, worrying about going to the store because it always makes your symptoms flare up). Or you may develop an anxiety disorder (ruminative thinking and hypervigilance). Here’s what it can feel like to patients:
- Feeling like you can’t relax.
- Feeling like you can’t stop worrying.
- Worrying about worrying.
- Constantly imagining how something can go wrong (“What if ... ?” thinking).
- Difficulty falling asleep (because of worry).
- Feeling uncomfortable and being unable to fix it.
- Feeling tense, such as tight shoulders or stomach knots.
To learn more about why patients experience anxiety after a brain injury and how it’s treated, read our patient’s guide to post-concussion anxiety.
Post-Traumatic Stress Disorder (PTSD)
The symptoms of a concussion and of PTSD can closely overlap. It’s often difficult to know which symptoms are from the concussion and which are from the PTSD. Post concussion PTSD can involve:
- Panic attacks
- Flashbacks and exaggerated startle response
- Difficulty sleeping
- And more
Patients with PTSD often need PTSD-specific therapy in addition to post-concussion treatment. To learn more about why patients experience PTSD after head trauma and how it’s treated, read our patient’s guide to post-concussion PTSD.
TBI-Related Emotional Changes, Anger, and Mood Swings (“Personality Changes”)
Some patients (or their caregivers) think their personalities changed after the brain injury. If this is you, understand that your personality is likely intact. It’s just buried under the weight of difficult symptoms. Mood disorders after a concussion can include:
- Social anxiety
- Irritability and anger
- Mood swings
- Feelings of overwhelm
To learn more about why TBI patients experience emotional changes after a brain injury and how they’re treated, read our patient’s guide to post-concussion personality changes.
Treatment for Mental Health Symptoms After Brain Injury
Treatment approaches for mental health struggles after brain injury include medication, neurorehabilitation, psychotherapy (especially cognitive behavioral therapy), and lifestyle changes. Here’s some more information on each.
Medication is often recommended by doctors who don’t treat the root cause of emotional changes after a brain injury. Sometimes these medications are helpful, but sometimes they can make things worse for your brain or just not do anything. For example, studies have shown headache medications are rarely helpful for brain injury patients. Don’t ignore your doctor’s advice, and don’t stop taking any medications without consulting your doctor, but do make sure your physician knows about any side effects you experience.
Unfortunately, many medications were only tested on neurotypical subjects, aka, people without brain injuries. A brain injury makes it easier for things to go wrong, resulting in side effects that may be difficult to distinguish from your head injury symptoms. For example, some headache medicines and depression/anxiety meds (especially SSRIs) can cause dysautonomia symptoms. So while medication can help, especially if you had a condition like major depressive disorder before your injury, it’s always best to treat the root issue rather than relying entirely on meds.
Further reading: Medication for post-concussion syndrome
At CognitiveFX, we provide multidisciplinary therapy to address the underlying brain dysfunction and dysautonomia from your injury, which in turn either greatly reduces your emotional symptoms or clears the way for you to make progress with psychotherapy and medications.
Remember how dysfunctional neurovascular coupling (the relationship between neurons and the blood vessels behind them) is behind the symptoms we discussed earlier in this post? Functional neurocognitive imaging (fNCI) can see which of your brain regions are experiencing this. Our clinicians can then use that information to prepare an individualized treatment plan.
“I was so anxious before I went because I had the feeling there would be nothing from the scan,” recounted patient Myrthe van Boon. That they would say again, ‘Sorry, we cannot find anything.’ But all the problems that I experienced were in the scan. So that was an emotional moment. After all those years, to think, ‘Wow, it is in my brain, and the things that I thought were wrong are,” she said.
What follows the scan is cognitive therapy, neuromuscular and physical therapy, occupational therapy, sensorimotor therapy, dynavision therapy, and other therapeutic interventions. You’ll also meet at least twice with a psychologist who can assess your needs and make additional recommendations for ongoing, follow-up treatment in your area of residence.
Chris Nicastro, a young man who sustained head injuries from wrestling and accidents, described one of his therapy exercises this way: “You stand on the Bosu ball, and you have to hit the lights when they light up, but you're doing things like reciting the alphabet backwards and all this crazy stuff at the same time. It's hard. Your body and your brain are a lot more powerful than people give them credit for,” he reflected. “You can do something like that and push your brain to the point where it rewires.”
Our treatment program is effective both for adults and pediatric patients.
Many patients start to notice a difference mid-treatment. Myrthe shared, "Halfway through the week, I went outside during my lunch break and the world looked totally different — brighter and clearer. My head was calm for the first time ever in all those years. It was an amazing and emotional moment. It gave me faith that this was going to work and would make a difference."
At the end of treatment, you’ll receive another fNCI scan so we can see how much your brain has improved. Each person improves at a different rate, but most report an average symptom improvement of 60%.
“The limitations placed on me by post-concussion syndrome are disappearing. I still have to respect my boundaries — I didn’t turn into a robot capable of working around the clock, and I can’t exercise as strenuously as someone who had never been injured (yet). But the quality of life increase from before to after is significant,” said one adult patient who had sustained a sports-related concussion and orthopedic injuries in childhood.
Cognitive Behavioral Therapy for Brain Injury
Cognitive behavioral therapy (CBT) is often a helpful addition to neurorehabilitation for persistent post-concussive symptoms. CBT is based on the idea that cognitive, behavioral, and emotional patterns are all connected. Changing one in a good way can influence all the others.
CBT’s mental health outcomes have been well researched. Studies show that CBT can be used to treat anxiety, depression, insomnia, post-traumatic stress disorder, and a number of other mental health conditions.
Note that cognitive behavioral therapy and cognitive therapy are not the same. CBT methodically teaches you how to transform your thought patterns and behavior. Cognitive therapy works to correct neurological and cognitive deficits such as poor memory, language processing deficits, and brain fog.
Not everyone with symptoms after a brain injury needs cognitive behavioral therapy; most do need cognitive therapy. If mood disorders persist beyond neurorehabilitation, then we often recommend CBT, as long as you receive it from a certified psychologist. When possible, we will make a referral to treatment providers we trust. You can look for CBT specialists on these websites:
Certain changes to your routine can also help minimize the impact of emotional struggles on your life. Here are some of the changes that have the most impact on concussion recovery.
Exercise after a brain injury isn’t always easy. You might find yourself quickly short of breath, suffering from a headache, feeling nauseated, and more. But there are safe ways to exercise after a concussion, and they can make a significant impact on your physical and mental health.
Consume a Brain-Boosting Diet
What you eat is always important, but it’s even more critical when your brain is recovering from injury. Focus on drinking enough water; consuming healthy greens, fruits, nuts, and fish; and avoiding processed or sugary foods. You’re likely to notice a positive change in cognition and other aspects of recovery.
Note: Some people turn to alcohol or pain medications to cope with symptoms after their injury. Not only can that inhibit recovery, but the practice can easily lead to substance use disorders. If you need help with substance abuse, please see SAMSA’s national hotline and educational resources (for those in the U.S.). Recovery is possible and there are people who want to help you get better.
Get Better Sleep
Brain injury can interfere with your sleep quality. And while some of those effects may not resolve until you’ve received therapy, there are still steps you can take to encourage a better night’s sleep. Keep a consistent sleep schedule; maintain a clean, dark room; use blue light filters and avoid screens near bedtime; and consider low doses (0.5 mg to start) of melatonin if you need it.
Learn more: Getting a good night’s sleep after an mTBI
Destimulate Your Brain
Taking more breaks during the day is one way to reduce the stress on your brain and emotions. But many people don’t realize when to take a break or how to make it the most effective. Following some simple rules regarding rest will help your recovery and also reduce emotional flare-ups.
Not every brain recovers at the same rate, and there’s no set timeline to heal from physical and emotional trauma. Focus on what you can do each day to keep improving your overall wellness. The severity of your injury could impact how much you’re able to recover, but that doesn’t mean you can’t achieve a better quality of life than you have now.
In the meantime, if you’d like to read more about other patients’ experiences, see our post on what it’s like to live with post-concussion syndrome.
Over 80% of our patients — adults and adolescents alike — have experienced emotional symptoms after neurotrauma. Many of those symptoms resolve shortly after treatment at our clinic (although persistent mental health issues such as depression and anxiety can take additional therapy to resolve).
If you’d like to learn more about how we can help you, book a consultation.
About Dr. Alina Fong Ph. D.
Dr. Alina K. Fong received her Ph. D. in Clinical Neuropsychology with an emphasis in neuroradiology from Brigham Young University. She received the national American Psychological Association Clinical Neuropsychology Division 40 Graduate Student Research Award in 2004 for her research on "Cortical Sources of the N400 and 'The N400 Effect." Dr. Fong's interest in brain mapping soon turned to functional MRI, and since then, her research efforts have been focused on the clinical applications of fMRI.