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Navigating Mental Health After Severe TBI and Concussion
Dr. Alina Fong PhD

By: Dr. Alina Fong PhD on January 22nd, 2021

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Navigating Mental Health After Severe TBI and Concussion

Mental Health Support After a Brain Injury  |  Traumatic Brain Injury  |  Education & Resources  |  Post Concussion Treatment

Mild and severe traumatic brain injury (concussion and TBI) can cause upsetting changes to your mental health. You may find that preexisting mental illness worsens after your injury or that new symptoms —  such as anxiety, depression, mood swings, anger, post-traumatic stress disorder (PTSD), and more — arise. Don’t give up hope: There are good treatment programs that can help you improve.

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. 

So if you’re wondering if you’re going crazy or are blaming yourself for the emotional turbulence you feel, please don’t! It’s very common to experience emotional struggle after a brain injury. And with the right help, you can feel better again. The key is to treat the brain injury first, then focus on any stubborn 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:

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 serious 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 free consultation.

What Causes Mental Illness After Traumatic Brain Injury?

A woman stares pensively out the window with her hand on her chin and someone else's hand on her shoulder.

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) and hyperactive brain regions (areas that try to do extra work to make up for underperforming regions of the brain, and those that call for more resources than they need for the work they do).

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 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 and 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).
  • Headaches.
  • 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, paying attention, worse short-term memory, difficulty with word-finding — all symptoms that are very frustrating to experience).
  • Fatigue.
  • Hormone dysregulation.

Finally, any mild TBI 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?

Depression, anxiety, PTSD, anger, teariness, and mood swings are some of the mental health issues you might have after a concussion or severe TBI.

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 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.

Depression

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.
  • Indecisiveness.
  • Suicidal ideation.

To learn more about why patients experience depression after a brain injury and how it’s treated, 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. 

Anxiety

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:

  • Anxiety.
  • Panic attacks.
  • Flashbacks and exaggerated startle response.
  • Overwhelm.
  • Difficulty sleeping.
  • Avoidance.
  • Depression.
  • 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.

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.
  • Teariness.
  • Irritability and anger.
  • Mood swings.
  • Feelings of overwhelm.
  • Impulsivity.

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

A client at CFX listening to binaural beats.

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. 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 SNRIs) can cause dysautonomia symptoms. So while medication can help, it’s always best to treat the root issue rather than relying entirely on meds. 

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. We then use that information to prepare a targeted treatment plan to correct it.

What follows is a week of cognitive therapy, neuromuscular and physical therapy, occupational therapy, sensorimotor therapy, dynavision therapy, and more. 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.

At the end of the week, you’ll receive another fNCI scan so we can see how much your brain has improved. On average, our patients show 75% improvement on their post-treatment scan!

Click here to learn more about our EPIC Treatment Program.

Keep Trying!

A photo showing a family putting their hands on top of each other.

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. 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 have experienced emotional symptoms after a concussion. Many of those symptoms resolve shortly after treatment at our clinic (although serious 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 free consultation.

About Dr. Alina Fong PhD

Alina K. Fong received her PhD 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.

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