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Researchers found patients with traumatic brain injury suffered from major depression for a year after the injury.  A new study conducted by scientists at the University of Washington School of Medicine in Seattle revealed that traumatic brain injury may lead to major depression.

Unfortunately, the people I counsel often do not have resources to obtain treatment during that initial 12 month period.  Often they lose their jobs and insurance and are left to navigate the medical system alone.  This is impeded by organic depression which in turn creates more depression: situational and otherwise.

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Dealing with Brain Injury symptoms and consequences quite frequently, I am exposed to the contention that Depression is the culprit when it comes to the subjectivity of pain.  Subjective pain is that which is rated according to the one complaining, not the observer.  Objective pain is that which can be observed independent of the one complaining.

Brain Injured Victims are often accused of malingering pain symptoms as a result of being depressed.  And the depression is dismissed as a personality flaw or pre-existing a brain injury.

Well this is the what came first argument: the chicken or the egg.  Certainly there is medical support for the statistics of depressed patients being more likely to report subjective pain symptoms.  Also there are statistics supporting the evidence that pain leads to depression.

It is difficult to weed out the two but that difficulty is not justification to dismiss complaints of pain due to depression or depression being the true source of pain.

 When it comes to pain, the two competing schools of thought are that it's either "all in your head" or "all in your body". A new study led by University of Oxford researchers indicates that, instead, pain is an amalgam of the two.  Dr. Chantal Berna and colleagues used brain imaging to see how healthy volunteers responded to pain while feeling low.

 The article is "Induction of Depressed Mood Disrupts Emotion Regulation Neurocircuitry and Enhances Pain Unpleasantness" by Chantal Berna, et al. Berna, is affiliated with The Centre for Functional Magnetic Resonance Imaging of the Brain, Department of Clinical Neurology and Nuffield Department of Anaesthetics, University of Oxford, Oxford, United Kingdom.

The article appeared in Biological Psychiatry, Volume 67, Issue 11 (June 1, 2010), published by Elsevier.  The authors' disclosures of financial and conflicts of interests are available in the article.
 

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TheAmerican Medical Association study links depression and traumatic brain injury. Survivors of concussions are almost eight times more likely to become clinically depressed, researchers report.

In the year following a traumatic brain injury, roughly half of survivors likely experience a bout of clinical depression -- a rate almost eight times higher than that found in the general population, says a study published  in the Journal of the American Medical Association. And those whose head trauma was followed by depression reported significantly more pain, greater mobility problems and more difficulty carrying out their usual responsibilities than those who were not plagued by post-injury depression.

Traumatic brain injury, or TBI, is sometimes called concussion. Often called the "silent epidemic," it affects some 1.5 million Americans yearly. Its symptoms are often subtle -- including personality changes, problems of memory and concentration, headaches and mood disturbances. While for most, the effects of a head trauma will clear within a year, many have more lasting effects. For at least 80,000 people a year, major disability will follow.  

The 559 participants in this study had all come to a trauma center in the Seattle area with a head injury, signs of brain trauma that could be detected by a CT scan, and at least a few complications -- including loss of consciousness, disorientation or other factors that qualified them as scoring at most a 13 on the 15-point Glasgow Coma scale. Over the next six months, and then again at eight, 10 and 12 months after the participant's injury, researchers conducted a detailed telephone interview to gauge his or her mood state and ability to function. The result, said the researchers, was likely to yield a conservative picture of how many suffered from depression.

LA Times reporter Melissa Healy interviewed Dr. Hovda, a UCLA biologist who said, "the study made clear what clinicians had long suspected: "Major depressive disorder can have severe consequences for recovery from TBI."

But the study didn't explore some important distinctions, said Hovda, who was not involved in the research. Among those are whether repeated concussions — like those suffered by some U.S. troops and athletes — might make depression more likely than a single, severe brain trauma.

Other factors were also correlated with depression after Traumatic Brain injury including being African-Amreican, being involved in litigation, not completing high school, or when the injury was caused by violence (as opposed to a vehicular crash, fall or recreational injury).

It is still questionable whether depression is related to organicity of the injury or psyhological affects of the injury.  The latter being more susceptible to treatment.  But the myth that depression is "all in your head" (seriously - no pun intended) continues to dispelled.  It a serious consequence of traumatic brain injury that can severly affect a persons ability to function.

To learn more about TBI and its sometimes-persistent effects, this comprehensive website can't be beat. To learn about local support groups and national and state efforts to improve life for those with TBI, check this website out.  

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A new classification of depressive subtypes of depression has been proposed in the current issue of Psychotherapy and Psychosomatics.  In keeping current on the new DSM being revised, as I have been writing about in previous posts, certain authors are recommending a revamping of depression subtypes to effect treatment. 

Lichtenberg and Belmaker argue that a simple diagnosis is no longer sufficient to guide treatment.  They propose the following subtypes:

Type A: Depression with Anxiety

Type B: Acute Depression

Type C: Adult Depression after Childhood Trauma

Type D: Depressive Reaction to Separation Stress

Type E: Postpartum Depression

Type F: Late-Life Depression

Type G: Psychotic Depression

Type H: Atypical Depression

Type I: Bipolar Depression

Type J: Depression Secondary to Substance Abuse or to a Medical Condition.

 One of the major challenges in treatment of depression seems to be the heterogeneity of the disorder. It is not uncommon to see significant differences in symptomatic presentation of depress patients.  Besides there are differences in age of onset, severity of course, treatment response and comorbid conditions. One assumption is that the heterogeneity is simply because there are different subtypes of depression,

says Tanvir Singh, MD and Alina Rais, MD, Dept. Psychiatry, University of Toledo Medical Center in their article entitled Subtypes of Depression.

I will anxiously await more information on the revised DSM.  For more information visit www.depression.com.

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 Daniel responds to my post on Understanding Depression at http://brainandspine.titololawoffice.com/2009/11/articles/psychiartric-psychological-iss/understanding-depression/

I appreciate the support because depression almost always results in traumatic brain injury cases I handle.  Not to mention the clinical nature of the disorder in non-traumatic brain injury cases.

Thanks for this interesting article. I think it is very important to talk about this topic, because it becomes more and more up to date. Lots of people are adversely affected by depression without knowing it. And this is very dangerous because of the consequences of not treating this suffering.

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Recall the recent post I made raising the issue of whether antidepressants were properly relied on by patients and physicians.  That post can be accessed here. http://brainandspine.titololawoffice.com/2009/12/articles/psychiartric-psychological-iss/antidepressant-may-change-personality/

 A new study appears in the December issue of The Annals of Pharmacotherapy.  (Published Online, November 24, 2009. www.theannals.com, DOI 10.1345/aph.1M326) Suicidal adolescents who were prescribed an antidepressant medication during inpatient psychiatric hospital treatment were 85 percent less likely than others to be readmitted within a month after discharge.

The results provide additional evidence that antidepressants may play a key role in helping improve the mental health of suicidal youth. Cynthia Fontanella, co-author of the study and assistant professor of social work at Ohio State University, points out that the the findings are especially important now, because antidepressant use dropped in 2003 after the Food and Drug Administration issued a black box warning that some antidepressants may increase the risk of suicidal behavior for pediatric patients. A black-box warning is the most serious type of warning in prescription drug labeling.

Despite considerable recent attention and wide-scale interventionsby regulatory authorities that have changed drug usage patterns,the possible relationship between psychotropic pharmacotherapy and suicidal behavior among children and adolescents remainsunclear. Confounding by diagnosis adds to confusion in the interpretationof the relationship between antidepressant use and suicidal behavior among young people. Cynthia Fontanella's recent research suggests that antidepressants may be protective against early readmission after hospitalization for suicide attempts or ideation, but that psychotropic polypharmacy (although common) may be associated with increased risk of rehospitalization.There remains an urgent need for high-quality, ongoing research into these clinical dilemmas.

Once again, I invite your input and thoughts on this issue by posting a comment.
 

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Have you ever considered the claims by celebrities, like Tom Cruise, or health care professionals that decry the impact of anti-psychotics and anti-depression medicine?  Have we come to rely on Prozac, Paxil and the laundry list of "feel good" medication to overcome what generations of folks have dealt with without them?  Or, is there a benefit reaped by those on the medication?  Do doctors overprescribe?  I am interested to know what you think.  Drop me a comment. 

The December issue of Archives of General Psychiatry, one of the JAMA/Archives journals,  reports Individuals taking a medication to treat depression may experience changes in their personality separate from the alleviation of depressive symptoms.

Two personality traits, neuroticism and extraversion, have been related to depression risk, according to background information in the article. Individuals who are neurotic tend to experience negative emotions and emotional instability, whereas extraversion refers not only to socially outgoing behavior but also to dominance and a tendency to experience positive emotions. Both traits have been linked to the brain's serotonin system, which is also targeted by the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs).

Read More Arch Gen Psychiatry.2009;66[12]:1322-1330.  Drop me a comment on your take on this issue.

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A new finding appears in Psychosomatics, the official journal of the Academy of Psychosomatic Medicine which publishes peer-reviewed research and clinical experiences in the practice of psychosomatic medicine/consultation-liaison psychiatry.

Poynter B, et al. Sex differences in the prevalence of post-stroke depression: a systematic review. Psychosomatics 50(6), 2009, find:

Depression occurs in as many as one-third of patients after a stroke, and women are at somewhat higher risk, according to a large new review of studies. Post-stroke depression is associated with greater disability, reduced quality of life and an increased risk of death.

The systematic review appears in the November-December issue of the journal Psychosomatics.
 

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Americans do not believe they know much about depression , but are highly aware of the risks of not receiving care, according to a survey released today by the National Alliance on Mental Illness (NAMI).

See full survey results at http://www.nami.org/depression.

The survey provides a "three dimensional" measurement of responses from members of the general public who do not know anyone with depression, caregivers of adults diagnosed with depression and adults actually living with the illness.

- Seventy-one percent of the public sample said they are not familiar with depression, but 68 percent or more know specific consequences that can come from not receiving treatment-including suicide (84 percent).

- Sixty-two percent believe they know some symptoms of depression, but 39 percent said they do not know many or any at all.

- One major finding: almost 50 percent of caregivers who responded had been diagnosed with depression themselves, but only about 25 percent said they were engaged in treatment.

- Almost 60 percent of people living with depression reported that they rely on their primary care physicians rather than mental health professionals for treatment. Medication and "talk therapy" are primary treatments-if a person can get them-but other options are helpful.

- Fifteen percent of people living with depression use animal therapy with 54 percent finding it to be "extremely" or "quite a bit" helpful. Those using prayer and physical exercise also ranked them high in helpfulness (47 percent and 40 percent respectively).

- When people living with depression discontinue medication or talk therapy, cost is a common reason, but other significant factors include a desire "to make it on my own," whether they believe the treatment is actually working and in the case of medication, side effects.

"The survey reveals gaps and guideposts on roads to recovery," said NAMI Executive Director Michael J. Fitzpatrick. "It tells what has been found helpful in treating depression. It can help caregivers better anticipate stress that will confront them. It reflects issues that need to be part of ongoing health care reform."
 

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The British Journal of Psychiatry,  available online, published findings that good diet contributes to less depression.

A new study led by researchers in the UK found that an overall healthy "whole food" diet comprising a high proportion of fruits, vegetables and fish, protected middle aged people against depression compared to a processed food diet containing a high proportion of high fat dairy food, processed meat, fried food, refined grains and sugar-laden desserts.

 Read More Here.

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The American Association of Neurological Surgeons reported research on Depression this month.

Electroconvulsive therapy (ECT) is effective in approximately 70 percent of cases in which antidepressant medications do not provide adequate relief of symptoms. However, as many as 20 to 50 percent of patients who initially respond well to ECT treatment, suffer a relapse within six months, therefore, periodic maintenance therapy is often required.

Researchers at three medical schools, Harvard, University of Pittsburg and Medical College of Wisconsin, counducted a study entitled "Long Term Follow-up of Cortical Stimulation to Treat Major Depressive Disorder."  They investigated ECT stimulation for patients with major depressive disorder.

The World Health Organization rates major depression as the top cause of disability worldwide, with an estimated 340 million people suffering from an episode of major depression every year. While most patients with major depression find relief through a combination of psychotherapy and medication, about 20 percent of patients fail to respond. Patients who are most resistant to medications, psychotherapies, and electroconvulsive therapy (ECT) have little hope of recovery, and suffer a heightened risk of suicide and mortality. Sadly, statistics show that the suicide rate in people with major depression is as high as 15 percent.

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An article in the LA Times reports a study concluding that Brain Stimulation Improves Severe Depression.

Major depressive disorder affects about 14 million people in the U.S., and 10% to 20% of them do not respond to standard medical treatment, according the study.

In the fast-paced atmosphere of the modern world, where everyone has somewhere to be or something that needs to be taken care of, it's very easy for our lives to fall out of focus. Whether we're taking care of the needs of others or pushing to maintain our stamina in a hectic workplace, we often put our own personal needs at the end of our to-do lists. It's very easy for the blues to hang on a little longer than it should.

The nine men and 11 women in the trial had not improved on multiple medications, psychotherapy and electroconvulsive therapy. Subjects had been taking an average of four medications when the trial began in 2003 and had suffered from major depression for an average of 6.9 years.

Deep brain stimulation is approved to treat essential tremors and Parkinson's disease. Electrodes, which are permanently implanted in the brain, are powered by batteries and can be turned on and off by an external controller.
 

A new study with expanded participants is underway.

Read the article by clicking here.

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