Depression
Depression is a condition that falls under the category of mood disorders.
A depressed mood occurs when an unusual sadness and/or listlessness persists for a prolonged period (more than two weeks).
This sadness or listlessness is often accompanied by a loss of interest, zest for life, or pleasure.
In addition, the following symptoms may occur: sleep disturbances, fatigue, difficulty concentrating, weight changes, and/or thoughts about death.
Sadness (depressive symptoms) is actually a normal emotion after the onset of acquired brain injury and can be indicative of a processing problem. After all, life has completely changed, and the future prospects are shattered.
Depression due to health loss
Life can be completely different after a brain injury. This is often difficult to accept. Someone might have to use a wheelchair, can no longer go home, or can no longer work. Their appearance can be significantly altered with half-sided paralysis, and facial expressions can be profoundly altered.
When a person is no longer able to express herself or himself or to speak due to aphasia, this can play a significant role. This can be very frustrating.
Apraxia can be just as frustrating. When you no longer know how to dress you and put your underwear on over your long pants, realizing it's not right, but what should you do?
These experiences of loss can lead to significant grief. This feeling is similar to grieving the loss of a loved one. It's called living loss. There is no death involved. There is grief for what has been lost. A person can then become depressed.
Depression brings with it significant psychological suffering. Physical functioning also deteriorates.
In fact, becoming depressed is a healthy reaction to a traumatic and life-altering event. That's how it works during the grieving process.
Depression due to the location of the lesion in the brain and neurobiological factors
Depression can occur as a direct result of the location of the lesion in the brain. For example, people with lesions in the left hemisphere of the brain appear to have a slightly higher risk of depression, although this may differ for left-handed people. Consider, for example, lesions in the hippocampus (seahorse), pituitary gland, pineal gland or cerebellum.
There are studies that contradict this "lesion location theory" (Lesion = injury. Location = linked to a specific brain area).
There may also be blood vessel-related causes (vascular causes) and neurobiological factors that may play a role. For example, serotonin deficiency or the 'cerebral immune activation and inflammation factor' (cytokine hypothesis).
Depression occurs in 20-50% of stroke survivors in the first year.
This makes depression the most common neuropsychiatric syndrome after a stroke. It is called poststroke depression (PSD).
This also occurs in 25% of people with traumatic brain injury in the first year. No figures are yet available for other causes of brain injury.
However, it is important to distinguish between depression and depressive symptoms. People with brain injuries often score high on a short "depression test" because they feel tired and take less initiative, experience difficulty concentrating, or have altered sleep patterns. These can be purely consequences of the brain injury, but they don't necessarily reflect a person's mood.
Note: neurofatigue is different from simply being tired.
A short test that is often used is the Four Dimension Symptom Questionaire.
Being Overloaded
Depression due to overload and feeling under pressure from overload are common in people with brain injuries. Many people with brain injuries have limited resilience and therefore more often end up with burnout.
Perhaps they still have the will, but they simply can't anymore.
In this case, it's crucial to match resilience to the workload.
Difficulty controlling muscles (ataxia) and feelings of depression
If depression-like symptoms occur alongside the ataxia, CCAS, cognitive cerebellar affective syndrome,
which can occur with disorders of the cerebellum, should also be considered.
Read more on the CCAS page.
The renowned Dutch psychiatrist Bram Bakker wrote a book about his search for the cause of his symptoms, for example ataxia.
It turned out to originate in his cerebellum, and he was diagnosed with CCAS.
Read more on our other page on depression
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