Depression in Cases of Traumatic Brain Injury
Depression in traumatic brain injury cases is a classic symptom. Traumatic brain injury is associated with an increase in the relative risk of developing a variety of psychiatric
disorders, particularly depression and cognitive impairment.
This relationship is best understood in the context of both the neuropathophysiology and the typical profile of regional brain injury associated with biomechanical trauma. The disturbance of brain function from MTBI is related more to dysfunction of brain metabolism rather than to structural injury or damage. The current understanding of the underlying pathology of MTBI involves a paradigm shift away from a focus on anatomic damage to an emphasis on neuronal dysfunction involving a complex cascade of ionic, metabolic and physiologic events. Clinical signs and symptoms of MTBI such as poor memory, speed of processing, fatigue, and dizziness result from this underlying neurometabolic cascade.
The relationship is further understood as the psychosocial sequelae that often follow the injury and their attendant effects on social, vocational, and family functioning. Thus, in many ways TBI
is a prototypical neuropsychiatric disorder.
There remains much that is incompletely understood about neuropsychiatric and functional outcome after TBI. Individuals may have disparate long-term outcomes after seemingly similar injuries. Probable contributors to this variance include preinjury host factors, injury-specific
biomechanics, and genetic factors. Further investigation of these matters is needed to improve our ability to understand, identify, and more effectively treat those individuals at risk for poor outcomes following mild TBI.
Currently, a multidimensional approach is critical to the assessment and treatment of the neuropsychiatric sequelae of mild TBI. The most important initial step is accurate diagnosis, which can be challenging in cases of mild TBI. A combination of psychotherapeutic and
pharmacologic interventions can alleviate many symptoms, and improved quality of life for persons with TBI and their families can be achieved.
Psychiatrists, armed with a neuropsychiatric approach to mild TBI, are critical members of the health care team attending to persons with mild TBI and have an important role in the
management of this significant public health problem.
I typically involve a psychiatrist in the treatment team, along with a neurologist, neuropsychologist, neuroradiologist, and others in my cases.
