Concussion is a condition in which the brain is bruised from a traumatic injury to the head. This injury leads to a wide variety of symptoms that are unique in each individual that presents. It is important to address all such symptoms to properly manage patients. The psychosocial factors of depression and anxiety play a dominant role in some individuals suffering from concussion. Addressing these symptoms is imperative in the recovery of these patients, especially those suffering from Post Concussion Syndrome. Review studies have found that psychological disturbances contribute to symptoms during acute PCS, persist in patients with prolonged PCS and predict late outcomes for recovery.
PCS and Depression
The Mayberg cortical limbic model of depression is widely accepted and suggests that depression is mediated by a difference in blood flow and glucose metabolism when compared to the average person. The model found that in patients with depression and healthy patients with induced sadness, there is increased blood flow to the ventral paralimbic region of the brain as well as decreased blood flow to the dorsal neocortical region of the brain.
Studies have suggested that approximately 12-44% of individuals suffering from traumatic brain injury will develop some level of depression within the first three months. The reason behind the alarming statistic can be attributed to anatomy. Individuals suffering from brain injury often have dysfunction of the frontal and temporal lobes, which are integral to the cortical limbic pathway affecting mood. The severity of depression can be due to numerous factors, including degree of injury and disruption to this pathway, prior history of psychological conditions, the social circumstances (such as the possibility of losing career/scholarship for athletes). For non- professional athletes prolonged recovery and persistent depression may be due to the fear of re injury. Other causes of prolonged depression could be due to withdrawal from all activity as physicians often suggest rest as the primary treatment for concussion.
Studies have suggested that approximately 12-44% of individuals suffering from traumatic brain injury will develop some level of depression within the first three months. The reason behind the alarming statistic can be attributed to anatomy. Individuals suffering from brain injury often have dysfunction of the frontal and temporal lobes, which are integral to the cortical limbic pathway affecting mood. The severity of depression can be due to numerous factors, including degree of injury and disruption to this pathway, prior history of psychological conditions, the social circumstances (such as the possibility of losing career/scholarship for athletes). For non- professional athletes prolonged recovery and persistent depression may be due to the fear of re injury. Other causes of prolonged depression could be due to withdrawal from all activity as physicians often suggest rest as the primary treatment for concussion.
By Seethal Moramarri and Mo Mortazavi, MD
References
Broshek DK, Marco APD, Freeman JR. A review of post-concussion syndrome and psychological factors associated with concussion. Brain Injury. 2014;29(2):228-237.
Limbic-cortical dysregulation: a proposed model of depression. The Journal of Neuropsychiatry and Clinical Neurosciences. 1997;9(3):471-481.
Images
https://www.pexels.com/photo/design-desk-display-eyewear-313690/
https://www.pexels.com/photo/man-in-blue-and-brown-plaid-dress-shirt-touching-his-hair-897817/
