Concussions and Depression
Concussion: An Invisible Injury
It is common for people to feel low after suffering any physical injury; you might be dealing with pain, frustration related to your recovery and limitations, and grief that your body and abilities have been compromised in some way, even if it’s just for a short while. When it comes to concussion, however, there is the added burden of an, “invisible” injury; you might look, “normal,” and feel anything but normal.
Where relatives might be more generous with help and support for a broken leg, or friends might be more patient with a sprained ankle, I often hear stories of pain and frustration of those recovering from concussion perceiving their loved ones as tired, irritated, or forgetful of the difficulties the person is experiencing. Difficulties with memory and attention, feeling more emotionally reactive, fatigued, and dizzy are frequently reported symptoms immediately post-injury.
With a broken leg or sprained ankle, there are often visible and obvious signs of an injury: a cast, crutches, a brace, or a limp.
When recovering from concussion, the unseen nature of the injury can leave the person feeling like they have not only the burden of their injury, but the responsibility of having to “prove” they are injured and remind loved ones that their difficulties are symptoms of said injury.
Concussion Recovery
Concussions are also different from other visible physical injuries in that recovery timelines have the potential to vary. Whereas broken bones may be expected to heal in 2-3 months with reassuring check-ins throughout that time, concussion recovery can be more nuanced, especially when symptoms often overlap with symptoms of acute stress, anxiety, depression, and sleep deprivation. Thus, a concussion can feel as though it takes away one’s certainty in a firm recovery timeline, leading you to wonder, “am I always going to be like this?” Naturally, this can lead to feelings of hopelessness, helplessness, and isolation. In addition, there is a lot of misinformation readily available that feeds fears of permanent damage, risk of brain disease, and death, increasing one’s experience of unease and hopelessness.
Gentle Reminders
A few gentle reminders that I often give to those living with concussion and depression:
As best as you can, remember that ongoing symptoms are not a sign that you are not progressing; some symptoms just take more time than others to resolve. Just because you have the same symptoms as you did when you were first injured, does not mean that you have not made any progress. For instance, you may still have headaches triggered by loud noises, but perhaps those headaches are less frequent, less severe, or reduce in intensity more quickly than they did right after your injury. Also, perhaps other factors are contributing to these same symptoms, like an irregular sleep schedule, social responsibilities, or relationship stresses.
Stress and anxiety have a lot of the same symptoms of a concussion: headaches, dizziness, loss or increase of appetite, difficulty focusing, memory troubles, sleep difficulties, fatigue, and emotional reactivity. While there is no way to perfectly identify and parse out what part of your symptoms is due to concussion versus stress, incorporating stress management techniques and looking after your physical and mental health will surely have a positive effect. Building in time to speak with a trusted friend or family member, journaling, or meeting with a counsellor may help you manage stress and be better prepared for physical components of your rehabilitation.
Slowly incorporate more physical activity into your life where you can. Though it’s likely not realistic for you to run 10km every day post-injury, perhaps you can make a practice of opening the window and breathing in fresh air for 5 minutes each day. Go for walks for 1-2 minutes each day in front of your house, or even down your hallway as you can. Physical activity is linked to improved physical and mental health, so as best you can, keep your body moving throughout your recovery.
Celebrate the successes. It is so easy to compare our current functioning to pre-injury, or to others’ functioning, or to the hopes and plans and expectations we hold for ourselves. However, comparison robs us of our ability to notice and track progress. Often times, our “wins” feel small when we start treatment (like remembering to take medication on time, or making yourself a cup of tea), but over time these successes build on each other. This is how progress is made - by noticing our efforts, acknowledging change, and working consistently at a sustainable pace.
Track your efforts. Whether it’s on a phone app, a calendar on your fridge, or a journal entry, note your efforts towards your goals. If your goal is to work towards a 30-minute walk each day, you may choose to start with 1 minute of walking; keep a note of that, and when 1 minute becomes comfortable, increase to 2 minutes. Eventually, with patience and consistency, you will see change and will be able to reflect back on how the time and effort you invested early on has gotten you to this place. We are naturally poor historians of time and progress when we are focused on our difficulties, so alleviate that stress and write it down.
Be kind and patient with yourself. More often than not, self-criticism, relentless feelings of guilt, and unrealistic expectations worsen symptoms and slow progress. When we find ways to cultivate acceptance and kindness, quality of life typically improves even in the unlikely event that symptoms do not.
Treatment Plan
Depression and concussion have much in common and can certainly co-occur; they are also both valid struggles for which you can access support and treatment. Alongside your doctor, and other rehabilitation specialists, like occupational therapists and counsellors, you can build a plan that works for you in your recovery journey. It’s important to note that managing stress, setting boundaries with yourself and others, and working gradually and consistently towards treatment goals are essential for both depression and concussion recovery.
At Panorama Wellness Group, we offer a trauma-informed, evidence-based approach to both concussion and depression support services. If you or someone you know is interested in working with Serena Graf (counsellor) regarding depression and concussion recovery, we encourage you to reach out. Panorama Wellness Group is based in the Murrayville neighbourhood in Langley, BC, with in-person and telehealth services available.
If you have any questions about this or anything else related to our work, please contact us at info@panoramawellnessgroup.ca.
Serena Graf is a Registered Clinical Counsellor with the British Columbia Association of Clinical Counsellors. She has worked in occupational rehabilitation, working predominantly with people who have survived concussions and mild traumatic brain injury (mTBI).
