The Caregiver's Journey

Depression

Many people with TBI become depressed. This depression comes from both the physical changes in the brain due to the injury and the emotional reactions to it.

It is sometimes hard to tell the difference between symptoms of depression and effects of the TBI. For example, depressed people and people with TBI may have:

  • Low activity level 
  • Sleep problems
  • Difficulty controlling emotions
  • Lack of initiation

Men and women often have different symptoms of depression. They also have different ways of coping with the symptoms.

Men often report symptoms of:

  • Fatigue 
  • Irritability/anger 
  • Loss of interest in pleasurable activities 
  • Sleep disturbances

Men are more likely than women to use alcohol or drugs when they are depressed. They may engage in reckless, risky behavior. Men also tend to avoid talking about their feelings of depression with family or friends.

Women are more likely to talk about depressive symptoms to others. They often report feelings of:

  • Persistent sadness 
  • Anxiety 
  • Excessive crying 
  • Feelings of guilt/worthlessness 
  • Decreased energy
  • Increased appetite 
  • Sleep problems 
  • Weight gain

In severe cases, both men and women may experience thoughts of suicide.

If you suspect that your family member is depressed, ask your healthcare team to evaluate his or her mental health. This is very important.

Depression can be treated with counseling and medication. If the depression is affecting the family, marriage and/or family therapy can help.

What you might see:

  • Persistent sad, anxious, or “empty” feelings 
  • Feelings of hopelessness and/or pessimism 
  • Feelings of guilt, worthlessness, and/or helplessness 
  • Irritability, anger, restlessness 
  • Loss of interest in activities or hobbies once pleasurable, including sex 
  • Fatigue and decreased energy
  • Problems concentrating, remembering details, and making decisions
  • Insomnia, early morning wakefulness, or excessive sleeping
  • Overeating, or appetite loss
  • Persistent aches or pains, headaches, cramps, or digestive problems that do not ease, even with treatment
  • Less attention paid to grooming and personal appearance
  • Thoughts of suicide, suicide attempts

How you can help:

  • Offer emotional support, understanding, patience, and encouragement. Remind your family member that depression usually fades with time and treatment.
  • Talk to your family member and listen carefully.
  • Acknowledge feelings, point out realities, and offer hope.
  • Get your family member involved in activities outside the house (e.g., walks, shopping, movies, church services, volunteering). If he or she declines, keep making gentle suggestions, but don’t insist.

Remember, depression is common as a person struggles to adjust to the temporary or lasting effects of TBI. Being depressed is not a sign of weakness. It is not anyone’s fault. Help is available ... do not wait to call someone if you think your family member needs help.

Know the signs of a person thinking of suicide: 

  • Making a will 
  • Taking steps to get affairs in order 
  • Giving away personal possessions
  • Sudden requests to visit friends or other service members/veterans
  • Purchasing a gun or stockpiling medications 
  • A sudden and significant decline or improvement in mood 
  • Writing a suicide note

Call 911 immediately or bring your family member to the closest hospital if you have any suspicion about suicide. It is perfectly fine to directly ask the person if he or she has been having suicidal thoughts. If yes, ask if he or she has a specific plan in mind. Having a plan for killing oneself is a serious sign to get help quickly.

Always take a person’s threats of suicide seriously. Get immediate help. Call the healthcare team or an emergency hotline (DoD/VA: 1-800-273-TALK) right away. Make sure to remove or secure any available firearms.