Depression After Traumatic Brain Injury

Abstract

Major depressive disorder (MDD) is the most common psychiatric illness in patients with traumatic brain injury (TBI). An estimated 50% of people who sustain a TBI are at risk of developing MDD in the 1st year after injury. Post-TBI MDD is associated with a number of symptoms that can impede recovery from both conditions and impact overall quality of life. Our understanding of post-TBI depression is best understood from a biopsychosocial model; therefore, biological, cognitive, psychosocial, and environmental mechanisms are explored in this chapter. Nevertheless, more research is needed to understand why, how, and in which people MDD develops. There is a lack of research on treatments for post-TBI depression that currently leaves clinicians without evidence-based recommendations to guide their treatment choices. We present a number of clinical considerations and recommendations for practitioners treating adults with depression after TBI, with some discussion about the importance of assessment in this population. We also emphasize the need of adapting or tailoring evidence-based, psychosocial treatments for depression, particularly cognitive behavioral therapy (CBT), for people with the most common cognitive and physiological sequelae of TBI (e.g., impaired cognition, headaches, light sensitivity), and briefly acknowledge the potential role of pharmacotherapy in treatment.