Mental health issues, such as depression, have been reported as a long-term consequence of traumatic brain injury. Concussions are a very common problem with athletes, particularly with football players. Therefore, it is easier to address this particular category of potential patients while examining the general causal links between head concussion and possible development of the clinical depression in the near or delayed future.
Traditionally, when an athlete gets depressed after suffering a concussion, the symptoms of depression are often attributed by coaches, other players and even doctors to psychological fallout from the injury: the athlete's loss of his place on the team, lack of teammate support, the often indefinite timeline to recovery, or the invisible nature of the injury, which can raise questions about whether the athlete is malingering.
A 2008 Canadian study of elite athletes playing contact sports, however, suggests that the symptoms of depression some athletes experience in the weeks, months and even years after a concussion may be the result of physical changes in their brains caused by the concussions themselves. Researchers at the McGill Neurological Institute in Montreal studied 56 elite male athletes using sophisticated MRI scans that allowed real time tracking of brain function as they performed a mental task. The findings, reported in the January 2008 issue of Archives of General Psychiatry, showed reduced activity in key regions of the brain of concussed athletes that have been linked in earlier studies with major depression. They also found lower gray matter densities in those areas.
The rate of diagnosed clinical depression among retired National Football League players is strongly correlated with the number of concussions they sustained, according to a study published in 2007. The study was conducted by the University of North Carolina’s Center for the Study of Retired Athletes and based on a general health survey of 2,552 retired N.F.L. players. It corroborates other findings regarding brain trauma and later-life depression in other subsets of the general population, but runs counter to longtime assertions by the N.F.L. that concussions in football have no long-term effects.
The study, published in the journal of the American College of Sports Medicine, found that of the 595 players who recalled sustaining three or more concussions on the football field, 20.2 percent said they had been found to have depression. That is three times the rate of players who have not sustained concussions. The full data, the study reports, “call into question how effectively retired professional football players with a history of three or more concussions are able to meet the mental and physical demands of life after playing professional football.”
What is Concussion?
Concussion is a type of mild brain injury in which there is temporary disruption of brain function, but no change in the structure of the brain. Concussion does not always include a loss of consciousness. Any of these symptoms may indicate a concussion: seizure or convulsion, amnesia, headache, neck pain, nausea or vomiting, dizziness, blurred vision, balance problems, sensitivity to light, difficulty concentrating, difficulty remembering, fatigue or low energy, confusion, or drowsiness.
For the player, an important aspect of concussion management is to recognize the symptoms and report the injury to the appropriate medical personnel. Management will include a period of rest to allow the brain to recover and a graded return to play.
Most people with concussion don’t need to undergo computed tomography (CT) or magnetic resonance imaging (MRI) scans of the brain. By definition, the CT and MRI scan of the brain is normal after concussion. CT is only required if a more serious brain injury or hemorrhage (bleed) is considered likely in the individual case. In most cases of concussion, the symptoms and signs resolve quickly and fully (over seven to ten days), and there are no long-term effects. However, in a very small number of people with concussion, the symptoms may persist for a longer period, sometimes weeks, months, or even years.
Concussion and Depression
Linking concussion with later onset of mental disease, such as depression and suicide is very complicated. It has been shown that depression can occur in one out of every eight people in the community. Some of these people will also have had a sports concussion. But, did the concussion cause the depression, or was it going to develop in that individual anyway? There are many factors that contribute to the onset of depression, including genetics, chronic pain, illness, drugs and alcohol.
Some sports people with chronic injury (such as knee osteoarthritis or chronic back pain) will develop depression secondary to the chronic pain and disability of that injury. If they once had a concussion, some will want to blame the concussion as a cause for the depression. This is what the American lawyers are claiming in some of their cases.
There is no evidence that a single concussion results in the onset of depression in later life. There is some evidence, however, that a history of three or more concussions may be associated with an increased risk of depression.
In 2003, the National Football League studied over 2,000 players with concussions and found a higher risk of depression in those who have not had head injury. Specifically, players who had 3-4 concussions had double the risk of depression compared to those who had no history. Those with 5 concussions had triple the risk.
McGill's Montreal Neurological Institute conducted a study using MRI imaging looking at brain activity. They found that MRI results of those athletes who had suffered from concussions had similar patterns of brain activity as people with major depressive disorder. They concluded that those who had no previous history of depression, after a concussion - had a higher risk of becoming depressed.
Post Concussion Syndrome
While minor infrequent concussions may not develop to the health related issue, there is known medical condition, representing the severe implications from the significant concussion. It is the Post Concussion Syndrome (PCS), also known as postconcussive syndrome. The traumatic brain injury is a type of concussion which occurs due to blow to the head and causes substantial negative effect to the patient health. The post concussion causes to the headache, dizziness, affecting the personality, mood and causing inability to interact with social work.
There is significant general difference, when females are suffering of post concussion syndrome more than in males. It is estimated that every year, there are more than 2 million people suffering from the PCS in the North America only.
The main symptoms of Post Concussion Syndrome include:
- Problems in concentration
- Problem in vision
- Rapid mood swing.
Chronic Traumatic Encephalopathy
Chronic Traumatic Encephalopathy (CTE) is a progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive brain trauma, including symptomatic concussions as well as asymptomatic sub-concussive hits to the head. CTE has been known to affect boxers since the 1920s. However, recent reports have been published of neuropathologically confirmed CTE in retired professional football players and other athletes who have a history of repetitive brain trauma. This trauma triggers progressive degeneration of the brain tissue, including the build-up of an abnormal protein called tau. These changes in the brain can begin months, years, or even decades after the last brain trauma or end of active athletic involvement. The brain degeneration is associated with memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, and, eventually, progressive dementia.
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