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Traumatic Brain Injury: The Invisible Illness
How a single concussion can change your life
Posted Apr 04, 2016
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Most of us are aware of the controversy surrounding concussions and football players — specifically, football
players receive concussion after concussion, ultimately retiring from their careers with higher rates of depression,
memory loss and even suicide. Researchers have found signs of chronic traumatic encephalopathy, a disease
caused by repetitive brain trauma, in 76 of 79 deceased NFL players including Dave Duerson, Junior Seau and
other football players who had lost their lives to suicide. The phenomenon even has its own Wikipedia entry.
(Sadly, football players who have committed suicide have their own Wikipedia entry as well.)
Concussions and other forms of traumatic brain injury aren’t limited to football players. In fact, traumatic brain injury
is one of the major causes of death and disability in the United States. Approximately 1.7 million Americans sustain
a traumatic brain injury each year, and 52,000 of those Americans die. Traumatic brain injuries make up nearly a
third of all injury-related deaths.
But what about the people who don’t die? Like football players, are they at risk for suffering long-term
psychological distress? Or are these consequences reserved for people who have experienced more severe forms
of brain injury?
What is a traumatic brain injury?
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Traumatic brain injury, often shortened to TBI, occurs when a sudden, external trauma causes damage to the brain.
As an example, a woman who hits her head on a dashboard during a car accident would likely sustain a TBI. The
infamous Phineas Gage, a man whose brain was pierced by a tamping iron during a railroad construction accident,
also had a TBI. A stroke, on the other hand, would not be a TBI, since the damage originates internally rather than
externally.
Between 2006 and 2010, the Centers for Disease Control and Prevention determined that falls were the leading
cause of TBIs at 40 percent. Unintentional blunt force trauma — in other words, being accidentally hit by an object
– took the dubious honor of second place at 15 percent. Car accidents and assaults were the lowest at 14.3 percent
and 10.7 percent respectively.
Some of the symptoms associated with traumatic brain injury are straightforward — a person who receives a blow
to the head might lose consciousness, develop a headache, feel lightheaded or lapse into a coma. Other
symptoms might seem a little unusual — for instance, TBI patients sometimes struggle with repeated episodes of
vomiting or have one pupil larger than the other. Still other symptoms are subtle and may appear to be entirely
unrelated to the injury — for instance, some people with TBI experience heightened levels of anxiety, depression
and mood swings.
Unfortunately, these latter symptoms often go ignored.
When traumatic brain injuries cause psychiatric symptoms
In 2013, a group of Danish scientists found that individuals with TBI (including concussions) were four times more
likely to develop a mental illness. People who had received a TBI were 65 percent more likely to develop
schizophrenia, 59 percent more likely to develop depression and 28 percent more likely to develop bipolar
disorder. This study is the largest of its kind and involved following 1.4 million Danish citizens born between the
years 1977 and 2000.
This study is far from the only one to suggest a link between TBI and mental illness. A research team led by
Jonathan Godbout, an associate professor at Ohio State University, found that mice that had sustained a TBI
demonstrated increased depressive symptoms as well as higher-than-normal levels of neural inflammation. (I have
previously written about mental illness’ surprising link to inflammation). Yet another study found that experiencing
depressive symptoms after a head injury is more common than not — the prevalence of depression after TBI is
greater than 50 percent.
The most frightening piece of research, however, was published earlier this year: People who had received a
concussion in the past were three times more likely to fall victim to suicide.
The risk of ignoring mild traumatic brain injury
Most of the people in the preceding research studies didn’t have severe traumatic brain injuries. Many of them had
received only mild concussions and treated them in the way most people treat concussions: a short visit to the
emergency room, bed rest and painkillers. They were not war veterans or football players. They were individuals
who left a car accident with just a headache and a sore neck, or student athletes who underestimated the speed of
a baseball.
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The brain is a delicate organ and, unfortunately, it does not take much to knock its chemistry out of alignment.
Even though receiving a concussion may be a tiny blip in most people’s memories, the ramifications of the injury
can follow them for the rest of their lives.
As a doctor, I repeatedly inquire my patients about head injuries because of how common they are. I ask not only
the patients, but also their close relatives and roommates. Once, I encountered a 39-year-old mother who
presented with anxiety, depression and psychotic symptoms. Although she claimed to have never suffered any
head trauma, her mother remembered that, at the age of 5, she had been in a car accident and lost consciousness
for more than 30 minutes. She later had a seizure. I placed the patient on an anticonvulsant, a drug designed to
reduce seizures, and she soon reported a decrease in her symptoms.
If you’ve received a head injury, don’t ignore it. If you feel anxious or depressed after a concussion, don’t assume
that the feeling is unrelated. Speak with your doctor. Get help. Traumatic brain injury doesn’t need to be an invisible
illness.
Contributed to by Courtney Lopresti, M.S. Neuroscience
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