One topic that’s close to my heart and almost always (!) comes up in conversations with people who have (had) traumatic brain injury, is depression.
I want to write about this, because I notice how this topic wallows in insecurities and questions and shame.
But “…shame hates it when we reach out and tell our story. […] It can’t survive being shared.” (Source: Brené Brown, The Gifts of Imperfection)
So here’s to an open and honest conversation about the period of depression many of us experience while we recover from post-concussion syndrome.
Note: types of depression
Depression in this post refers to feeling depressed or diagnosed clinical depression resulting from adverse life events, like in this case trauma and especially post-concussion syndrome.
It’s specifically not about other types of depression that may have been experienced before an incident or are caused by other (unknown) factors.
Depression, shame and responsibility
Most of us secretly wonder about others: am I crazy? Are others deprived of feelings, too? We wonder – but we don’t ask. And we certainly don’t share.
And I know why.
It feels like we’re doing something wrong.
It feels like we are responsible for our work failing, our relationships failing, our lives falling apart. We should be able to do better. We’re just not trying hard enough.
Depression in our society
We feel like abnormalities in a society that’s uncomfortable with discussing the darker parts of life. Also, the shadow of taboo continues to cover mental illness.
Doctors don’t tell us about the risk of isolation and the biological response to long-term adversity.
And, maybe most of all, our double illness, concussion and depression, is invisible to the outside world.
Unconsciously, our fears of failure and of not being good enough are poked because we can’t give what we gave before.
Because of these circumstances, we tend to overcompensate and after multiple setbacks, most of us turn inward.
We isolate ourselves, while sharing and turning outward is exactly what will help us to suffer less and to start an upward spiral in our lives again.
And sharing our stories and turning outward is exactly what will help others to feel less isolated, recognized and supported.
Depression is a biological response
From all my research, all my conversations, and in my own experience, I KNOW that many people with post-concussion syndrome feel alone. Feel isolated. Get depressed. Even think about death.
If you recognize this, or if you know you’ve felt depressed since your concussion, know that you are not the only one.
Especially know that feeling depressed after mild traumatic brain injury is a biological and protective response mechanism of your brain, which I’ll clarify later on in this blog post.
You can’t just will yourself happy
Answer this question for me: is feeling depressed something you would have chosen to feel, had you had the choice beforehand?
No, of course not! I know you wouldn’t.
So know that there are other and often greater forces at work than just your will to feel better.
What will help you to recover from depression (and you can!), is using this same willpower to decide to you’ll get better, no matter what.
In this blog post you’ll learn how normal it is to face a period of depression after a concussion – and I tell you what you can do, because it is absolutely curable!
Depression is normal and treatable!
I made this blog post to help you feel that you’re among equals here, and that what you’re experiencing is absolutely normal – and treatable. You’re not alone in this.
This post is for all of you who need to hear that what you’re going through is what many go through. That you aren’t crazy for how you (don’t) feel and what you think.
It’s for all friends and family members who want to understand their loved ones who are suffering.
And it’s for all medical personnel who believe in compassionate advice beyond the limits of functional protocols.
So – here goes. First, I’d like to answer some practical questions and share some insights that come up in conversations a lot.
Can concussions cause depression?
Will I get depressed because I have post-concussion syndrome?
No, not necessarily.
It’s a possible side-effect that you want to be aware of though.
You could talk about this risk with someone you trust, a friend or family member, to have them keep an eye out for you, too. This way, you don’t have to worry about it, and can still be aware.
I’m always positive, can I be depressed?
Getting depression doesn’t necessarily have so much to do with your natural state of being.
Depression has more to do with your circumstances (what happens to you), the way you view this (your beliefs) and your ability to deal with this (resilience and coping mechanisms).
Maybe, when you read the ability part, it feels like this is something you should have been capable of. No. A little further on, you’ll find out why you couldn’t have known.
And what’s more – focusing on what could have been is exactly what feeds your feelings of depression. Instead, I invite you to welcome the idea that truly everybody can get depressed.
Wellness and illness are not separate
Psychiatrist Professor Stephen Joseph explains very well how depression can happen to anyone. He writes (paraphrased):
Wellness and illness are not separate. This means that you aren’t either a sane or an insane person your whole life.
Feeling mentally well and unwell “lie along a continuum of human functioning”.
(Source: ‘Trauma, Recovery and Growth – Positive Psychological Perspectives on Posttraumatic Stress’.)
Everybody can get depressed
To put it simply, he says this:
What’s going on in your life + how this affects you = how you’re doing.
And how you’re doing can vary on this spectrum:
feeling perfectly happy and sharp <<<as opposed to>>> having lost all sense of meaning in life, unable to function
Even the most positive people can move from one side to the other side of the continuum in their lives, once or multiple times.
Everybody can get depressed if they’re hit with traumatic circumstances that they don’t know how to constructively cope with.
How depression develops after a concussion
In my humble opinion, the development of depression after a concussion, specifically post-concussion syndrome depression, is logical.
Let’s consider an example to understand how.
Suppose you’re a positive person, and you’re raised the way most of us are. Among others, we’re taught math, and English, and skills like collaborating with other children in school.
Then, we go on to specialize within a profession, whether that’s carpentry or law. If we’re lucky, we’ve had a careless childhood, and we’re off into the adult world – we have a whole life before us.
And then we sustain a concussion.
We never learned to cope with adversity
For all we’ve learned in school and our communities, most of us have never learned how to speak about and deal with adversity before.
When the concussion turns into post-concussion syndrome, most of us are left in an isolated situation.
The medical system doesn’t know what to do with us and loved ones can’t see our brain injuries. It’s hard for them to completely understand and thus give us the support we need.
Our brains don’t function and this means that we can’t concentrate to think our ways out of it. We can’t continue to do our work and the activities we love like we did them before.
Our natural positivity helps us to try and get up some days. On most days, though, it feels like it’s getting harder to get out of bed or manage even the smallest of tasks.
Let alone set a master plan into motion to get our lives back.
Don’t blame yourself for being depressed
If you recognize any part of my story, I know you’re not in an easy place and I want you to know that you’re absolutely not alone in this. Also, know that you’re not alone in being hard on yourself.
But… would you blame a friend if this situation forced them down on their knees after months of pain, social isolation and mental hardship?
Almost all of us feel this conviction before we realize the reasons underlying it.
But the reasons are there – and they can be found in how a concussion affects us in the long term.
The long-term effects of a concussion
After a concussion, depression can be a response to a ‘perfect storm’ of effects coming your way.
Professor Joseph writes that the impact of traumatic brain injury (including a concussion) isn’t just limited to the initial incident.
Namely, it also sets in motion a period of adversities piling up on top of each other. Let’s take a closer look at that to fully understand.
Concussion symptoms: the direct effects
Most of us experience physical and cognitive problems as a direct effect of sustaining a concussion.
These include but are certainly not limited to headaches, brain fog, sleep deprivation, an inability to find words and whiplash pains.
If these symptoms would bother you for a day or so, you wouldn’t be that effective for a day – and then you’d go back to normal.
But if these symptoms continue to disturb you, they are likely to affect your life in deeper ways.
Secondary effects on your life
Long-term concussion symptoms cause a wave of secondary effects that a concussion might have on your life. Let’s look at some examples to illustrate these.
Side-effects in our relationships
Suppose you can’t focus on conversations, and feel like your head explodes from the pounding headache of concentrating.
This might mean that you don’t have so much to give your loved ones as you did before. If so, this changes the dynamic of your relationships. How do your loved ones respond to this?
More often than not, this change is hard on both us and the people we care about.
A feeling of unwanted emotional disconnect is often described in my conversations with people like you, and I before.
Side-effects at work
Now suppose that you can’t stand to look at an illuminated screen for more than 3 minutes. A nauseating dizziness, vertigo and headaches might overwhelm your ability to think.
This might mean that you don’t have the capacity to do work you did before. If so, this changes the output that you can deliver at work. How does your boss or do your clients respond to this?
If you’re self-employed or are working for a small or medium-sized enterprise, you might face direct results: you might have lost your job or clients.
If you’re working for a big company, you might be lost in a disconnected battle over performance vs. recovery. If you’re in a “good” company, a company doctor might be appointed to you.
More often than not, I’m sad to say, however, I hear people describing how this doctor is supposed to be objective, but is pushing way too hard for full reinstatement and productivity.
Other secondary effects
These examples illustrate the adverse effects that a concussion might have on your relationships and work. But these are just the tip of the iceberg.
Hobbies, sports, social activities, being a parent, partner, caretaker, friend, sibling, provider: innumerable aspects of life might be negatively affected if a brain doesn’t work like it did before.
Do remember: I’m painting an honest picture of how a concussion may cause feelings of depression for everyone who recognizes these.
However, you don’t have to experience any or all of these negative side-effects. Also, you could experience some positive side-effects as well, like having the time to focus on yourself.
Moreover: the possibility of these effects doesn’t mean that they happen to everyone with post-concussion syndrome!
Tertiary side-effects: realizations of loss
So, Professor Joseph observed that our initial concussion symptoms affect our lives in so many areas and on profound topics such as our relationships and financial positions.
This might set into motion yet another layer of side-effects.
He found that these numerous adversities resulting from traumatic brain injury can cause realizations of loss.
Examples of loss
Let’s illustrate this with some examples to fully understand.
Suppose you can’t do your job like you used to anymore, because you can no longer depend on your brainpower. This can feel like you’ve lost the one thing that always made you excel.
Not being able to earn (enough) income can spiral into a series of losses, because you might be at risk to lose your house, and the social activities, sports and gatherings that cost money.
Maybe you feel you’re losing relationships that you thought would never break. But they do, and it’s because of a new disconnect that both of you don’t know how to repair.
Personality change after a concussion
Most of all, after a concussion, you might feel like you’ve lost yourself. Professor Joseph writes about the personality changes that he’s observed in his research:
“Perhaps the most distressing aspect of ABI [*Acquired Brain Injury] is the effect that the combination of losses has on the sense of personal identity.
A patient with ABI may be experienced by both herself and others as a totally different person.”
Depression during post-concussion syndrome
And it’s all these feelings of loss that can kickstart a period of mourning and depression if we have post-concussion syndrome.
Because feelings of loss on top of adversity naturally kick start a biological protective response.
The biology underlying depression
If we move through a phase of adversity and loss, a dormant system inside of us wakes up. It’s a system that responds to pain, loss and other adverse results. Let’s call it the danger system.
At first, the danger system yawns. It stretches. Its eyes open. And then it decides it’s been poked enough and it gets up to push aside our normal system of wonder and optimism toward life.
The concussion side-effects make us relax less
Because of our concussion symptoms and all the side-effects, we’re unable to continue to do the things that relax us and make us curious about life.
This causes us to call on our normal system of happy wonder less and less, and the danger system takes over. It starts to constantly warn us of all the danger, pain, and negative outcomes that lie ahead.
“Only pain ahead”
We feel like there’s nothing good to look forward to anymore. All this system tells you there is, is more of the pain and sorrow you’ve already had to endure. And this is why you feel depressed.
This is why you can’t feel joy, excitement or even ease anymore – it’s like you’re in stealth mode toward life.
And this is your biology – it’s our biology. This is why it isn’t your fault. The way you (don’t) feel is because of evolution protecting you.
Depression and thoughts of death
If you’re feeling depressed, it’s not uncommon that your mind wanders toward death. This is the warning system talking.
Essentially, what it says is: there’s nothing good coming anymore, and this is a way out. Know that this is faulty reasoning!
One – there are good things coming for you again, because there’s actually a clear path to depression recovery. I know the path, and many specialists with me, and it will work for you!
You can be happier than you’ve ever been, especially after the darkest of times – this is what happened for me, too! – and you don’t have to do it alone.
Two – think about all the happy moments and the love you’ve experienced before. It’s all still there, available to you – we only have to enable you to feel it again.
There’s just clouds blocking the sun and making you believe the sun is no longer there. So untrue!! As little as we believe this on a dark winter’s day, we should believe it right now.
Three – indeed, this road of depression isn’t leading you to good things, but disappearing from the road altogether isn’t the only solution. Far from it.
Once we take our eyes off our sorrow and internal struggles, and focus on our environment, we see that there are many side-roads that we can take and that there are a lot of people standing by to support us!
Four – if you were feeling like you used to do, when you were completely healthy, you would never think this way! It’s not you doing the thinking, it’s the depression.
You don’t have to listen, and you don’t have to engage in the stream of thoughts. You have a choice. And right now, choose to follow my lead. I promise you, I’ll guide you to full recovery.
If you think about suicide
If you’ve thought about suicide, or are thinking about it right now, know that you can call anonymously to the suicide prevention hotline of your country. Simply Google the number and don’t think about it: call.
They’re not just there for emergencies. They’re also there to talk about anything, free and without you having to tell them who you are. You can set your phone to anonymous if that helps.
Or, if you really don’t feel comfortable calling, reach out to a friend or family member whom you trust will be there for you. Whatever you do, reach out to someone who will support you.
The way out of depression
Now that we know the biological cause of feeling depressed, we also know the solution.
You have so much control without you knowing it. Everything that can be done to turn your feelings of depression around is within your own power.
Let me show you the steps you can take right now!
Step #1: you are not alone
If, while reading my story, you just realized that you recognize so much that you just know you’re depressed – know that you’re not alone in this.
There are many people like you and many caretakers who know how to get you where you want to be again!
Although this isn’t easy, there’s 1 thing you can do right now. Trust me on this.
Step #2: you are not your thoughts
You don’t have to listen to any thought that makes you feel bad, lousy, anxious, negative, empty, or causes you to do things that make you spiral down.
These thoughts come from the depression. You are not your depression.
See if you can recognize the thoughts, or the patterns or behaviors that don’t help you get to a better place. If you can observe them, you can choose not to engage in them.
You can choose not to follow the line of thought, and rather to talk with your depression as if it were a person (I know it sounds crazy,but it truly helps):
“I hear you, depression. Thank you for telling me, but this doesn’t help me. I’m going to think [this] instead,” and replace the depressive thought with a constructive one.
Then there’s 2 other things you can do right this moment.
Step #3: make 2 appointments
The next thing to do is to make an appointment with your GP to tell them that you believe you’re depressed. If it’s a good GP, they will refer you to a suitable psychologist.
If they do not, take charge and schedule the second appointment yourself: find and go talk with a psychologist whom you like and trust.
If the first psychologist isn’t right for you (this is just how it goes: just like someone can’t become your best friend, someone also can’t be the right fit for you to open up), find another – until you’re comfortable.
Don’t wait until things are bad
Please don’t wait until you feel like you’ve drifted so far that even picking up the phone is too much to do.
When we’re in the middle of the process, we never think it’s bad enough. Awakening incidents aside, we gradually spiral downward without noticing the month-to-month differences.
The risk of depression is too negative to take. The effects on your life are too impactful to risk. And the trouble of (preventative) treatment once a week is far too easy not to do it.
Step #4: do more of what made you happy
One other thing you can do from home already (this is not a replacement for finding professional psychological help), is to kickstart your normal system of curiosity and excitement again.
Doing this will help you switch back from the warning system to the normal excited-about-life-system that you need so much to feel happy again.
I’ve made a free worksheet for you that you can print right now. Answering the questions inside, you can get to work right away with what helps you and what sets you back!
It will help you uncover the thoughts, behaviors, events, situations and people that maintain or even intensify depression, and the things that will help you recover.
The PDF also helps you to then act on these discoveries and help you feel lighter already within a matter of days!
Remember, I’m right here with you, this whole website is dedicated to you.
You’re not alone in this.