When a person feels “down” or “blue” for a day or two and says he or she is depressed, this is not depression in its true, clinical sense. Actual clinical depression is a serious, life-altering condition that generally does not resolve without treatment. If someone is clinically depressed, he or she will exhibit at least five of the following symptoms, as described by the DSMV. There may be disturbances in his or her ability to sleep, resulting either in insomnia or excessive sleeping. Pleasure and interest in the activities a person once found appealing may be reduced. The sufferer may have feelings of guilt or worthlessness. In addition, he or she may be lethargic or fatigued, with lowered energy or, conversely, hyperactive and agitated. The ability to concentrate may have lessened. Changes in appetite and weight may occur, with the person either eating excessively or having little or no interest in food. There may also be psychomotor disturbances. Finally, the person may think or talk about suicide.

Depression’s causes are many. It may stem from a particularly traumatic event, such as the death of a loved one or the loss of employment. This is often called reactive or acute depression. By contrast, chronic depression is often less severe in its symptoms but lasts longer. Often, it will manifest itself in ways that dull a person’s ability to function fully in daily life, but not to the extent that he or she is totally incapacitated. Women are at higher risk of developing depression, and it can run in families.

Another type of depression arises directly from organic causes such as brain injury, although its victims exhibit similar symptoms. When the brain is damaged through either a traumatic injury or because of the effects of degenerative disease, the patient is forced to cope with a unique set of challenges. It is, after all, the healthy brain which contains the arsenal of tools that help someone to recover and be resilient when trauma occurs. If those very functions are, in and of themselves, targets of the injury, the patient may be even further crippled.

Although the skull may seem extremely hard and almost impenetrable, that is, unfortunately, not the case. There is only a quarter inch of skull between the outside world and the protective layers of fluid that surround the brain. It can be easily penetrated by an object such as a bullet or projectiles that may hit the head as a result of an accident. When the brain is pierced by skull fragments or external objects, this is called an external head injury. No less devastating is what is termed a closed head injury, in which the brain is shaken or is knocked hard against the skull, causing bruising and swelling. In either case, these injuries are termed traumatic, and can lead to many challenges, including severe depression.

Depending on the area of the brain that is hurt, the patient may experience a wide variety of short and long-term symptoms, some more severe than others. In many serious brain injury cases, some effects will be permanent and will mean that the patient loses certain abilities permanently and must find alternative ways of compensating. Sadly, it is not always possible for a patient to resume his or her former level of functioning.

When this realization fully dawns on the patient, he or she is in the most danger of becoming severely depressed. Generally, throughout the course of physical and rehabilitative treatment, the patient and his or her family are part of a multi-disciplinary team comprised of doctors, physical and occupational therapists, speech consultants, and social workers. All of these professionals should be well-versed in the evolution of the patient’s understanding of his or her injury, as well as the emotions that inevitably result.

It is also important to remember that family members, who are often a patient’s most vital long term support system, must also cope with many emotions throughout the treatment process. Although each situation is unique in many ways, all care-givers will have to grapple in the most intimate, daily way with the behavioral, emotional, and physical changes that the injury has brought about in the patient. That struggle can, in turn, lead care-givers into their own states of denial and depression. Fortunately, many advances have been made in recent years in the field of traumatic brain injury, not only in treating its physical manifestations, but also in assisting the patient and care-givers in addressing the emotional fall-out that results. This is a trend that will certainly continue, to the benefit of all parties involved.