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Concussions and Depression

Righttime Medical Care Hand Foot Mouth Disease

Participating in sports in middle and high school can be an energizing and confidence-building experience, but the impact of head trauma and concussions may leave kids and teenagers struggling with an inability to regulate their emotions during the recovery phase and ultimately lead to a battle with depression.

As we explore how concussions can impact the long-term health of adolescents and teenagers, let’s first look at what a concussion is.

What Is a Concussion?
A concussion is a type of traumatic brain injury (TBI). When the head sustains a blow or sudden jolt, it causes sudden movement resulting in the brain moving back and forth against the skull. That motion can cause chemical changes and cell damage in the brain. This video explains what happens to the brain during a concussion.

Signs of a concussion can include the following, and it's important to note that some of these may not appear until 24 to 48 hours after an injury:

  • confusion about time and/or place
  • worsening headaches
  • slurred speech or difficulty speaking
  • nausea
  • change in pupil size (one is bigger than the other, or both are abnormally enlarged)
  • trouble walking or standing
  • noticeable bruising or a large bump anywhere on the head

Signs of severe head injury include the following, in which case, 911 should be called immediately:

  • vomiting repeatedly
  • difficulty breathing
  • blood or fluid coming out of her nose or ears
  • seizure
  • loss of consciousness

How a Concussion Can Potentially Lead to Depression
Children and teenagers often become confused as to why they become so emotional after sustaining a concussion. Dr. Anthony Doran, a pediatric neuropsychologist with HeadFirst Sports Injury and Concussion Care, a service of Righttime Medical Care, says that the injury which causes other problems like headaches or issues with balance, can also have an adverse effect on regulating emotions.

“It’s the same brain. It’s the same reason as all the other symptoms,” Doran says. Up to 70 percent of children and teens who have sustained a concussion experience emotional dysregulation.

Kids and teens who already have a history of depression or anxiety may have their emotional symptoms exacerbated by the injury. What’s important is that the child and the parents realize that it is the head trauma that’s to blame, and adopt strategies for managing their feelings. Doran says it is important for parents to put so-called scaffolding in place – a system of identifying and helping children through the difficult weeks of recovery.

He suggests children and teens learn to gauge the intensity of the emotions on a scale, identifying whether they are a 2, which is at the lower end, or an 8 or 9, at the higher end. He recommends they take breaks from activity and actively recognize that their emotions are concussion-related, and not how one would normally feel. Relaxation techniques such as deep breathing and meditation can help. Parents can assist by talking their child through the process when they see them struggling and providing support or getting them when needed. It can take between four and eight weeks before the emotional dysregulation subsides.

While most concussion studies have focused on adults, few have explored the long-term effects of concussions on young brains. A 2014 study in the Journal of Adolescent Health found that children ages 12 to 17 with a history of concussions were more than three times as likely to suffer from depression than those who have never had a concussion.

Doran says children and teens with a history of depression are four times more likely to experience suicidal ideation but the issue is treatable with therapy, medication or both.

High school age students are more at risk for depression because they are already facing all the issues that come with being a teenager. “Add a concussion to that and they are more vulnerable,” Doran says. They are more apt to push away the parental scaffolding and struggle more – especially if they think they are at risk of losing their place on their team. Younger children are less likely to reject the help.

It is important for parents to know how to identify post-concussion depression after head trauma.

Know the Signs of Depression — And When to Help
If a child has suffered a concussion, then it is important to know the signs of depression that can emerge after an injury.

  • Feeling sad, hopeless, or irritable a lot of the time
  • Not wanting to do or enjoy doing fun things
  • Changes in eating patterns – eating a lot more or a lot less than usual
  • Changes in sleep patterns – sleeping a lot more or a lot less than normal
  • Changes in energy – being tired and sluggish or tense and restless a lot of the time
  • Having a hard time paying attention
  • Feeling worthless, useless, or guilty
  • Self-injury and self-destructive behavior

What You Can Do Before a Concussion
Protecting a child’s brain health starts before they step on the field or playground. Knowing and mitigating the risk of traumatic brain injury and concussion starts with a few basic steps:

Use the right protective gear. Ensure that your child has the appropriate head protection before they start playing. Make certain helmets (football, skateboard, bike, etc.) are age-appropriate and are rated for the sport they will be playing. Get help from an expert to ensure helmets are fitted properly for maximum protection.

Get a baseline neurological screening. Know your child’s brain health status before play begins. Many youth sports teams now require a baseline screening before children can play to quickly identify any cognitive changes after an injury. HeadFirst offers the ImPACT® neurocognitive baseline test for children ages 12 to 24. HeadFirst assisted in developing the pediatric version of the ImPACT test and remains one of the few concussion programs that offer it for children ages 5 to 11.

What to Do After a Suspected Concussion
See a licensed medical professional who is trained in evaluating head injuries. Depending on the severity of the injury, cognitive tests may be needed to gain a better understanding of the extent of the injury. Rest (both physical and mental) is usually the best treatment for a concussion.

Follow instructions. Your medical provider will carefully document a plan to rest the brain and reduce or eliminate stimuli such as computers, television, noise, bright lights, and physical and mental activities to give the brain time to heal. Also included will be a comprehensive, step-by-step process to return to school, work, play and activity. There is no quick answer to how quickly you or your child will recover. Symptoms typically improve within a few days or weeks, but can linger for a month or two, with other patients experiencing longer term symptoms and needing more time to recover.

Follow-up. Subsequent evaluations by a trained healthcare provider after symptoms have cleared up will verify that you or your child can resume normal school, work, home, sports, and activity routines.

 

HAVE QUESTIONS?

If you or your loved one sustains a suspected concussion, call Righttime Medical Care at 1-888-808-6483 for an appointment at any of our convenient locations, all of which have medical providers trained in evaluating head injuries. Righttime is open 365 days a year and welcomes walk-in patients anytime, while also offering same-day appointments online or via its Call Center.

Appointments for baseline testing for individuals ages 5 to 24, or for teams, are available at any HeadFirst clinic in Maryland by calling 1-855-SIT IT OUT (748-4868) or making an online appointment request.

The HeadFirst Sports Injury Hotline, a direct connection to an on-call physician, is available day, evening and weekends to coaches and athletic trainers who need assistance in performing a sideline evaluation of an injured player and advice for managing head injuries. Coaches and athletic trainers are welcome to receive more information regarding the hotline by completing the online form.

 

References:

Journal of Adolescent Health
https://www.jahonline.org/article/S1054-139X(13)00527-2/fulltext

Centers for Disease Control and Prevention, Children’s Mental Health
 https://www.cdc.gov/childrensmentalhealth/depression.html

Headfirst Sports Injury and Concussion Care
www.myheadfirst.com

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