Neuropsychology Review

, Volume 8, Issue 2, pp 95–108 | Cite as

Depression After Mild Traumatic Brain Injury: A Review of Current Research

  • Chardelle R. Busch
  • Herbert P. Alpern


Research pertaining to the occurrence of depression and/or depression symptomatology after a Mild Traumatic Brain Injury (MTBI) was reviewed. We found that methodological differences such as the criteria used to assess MTBI and depression, time that elapsed since brain injury, and control group variations confounded comparisons across studies. Nevertheless, the studies are consistent with at least a 35% prevalence of, and left frontal damage with depression after MTBI, an overlap of symptoms of depression and Postconcussion Syndrome (PCS), and indicate that depression can continue for many years following the injury. Our conclusion is that MTBI is the triggering event for a set of pathophysiological changes and a concomitant depressive episode in a vulnerable subset of the population. Due to a paucity of research, it cannot be definitively concluded that the underlying substrates of depression seen after MTBI and clinical depression are the same. Implications for future investigations are discussed.

Mild traumatic brain injury depression postconcussion syndrome head injury 


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  1. Alexander, M. P. (1992). Neuropsychiatric correlates of persistent postconcussive syndrome. Journal of Head Trauma Rehabilitation 1: 50-69.Google Scholar
  2. Aloia, M. S., Long, C. J., and Allen, J. B. (1995). Depression among the head-injured and non-head-injured: A discriminant analysis. Brain Injury 9: 575-583.Google Scholar
  3. Atteberry-Bennett, J., Barth, J. T., Lloyd, B. H., and Lawrence, E. C. (1986). The relationship between behavior and cognitive defects, demographics and depression in patients with minor head injuries. International Journal of Clinical Neuropsychology 8: 114-117.Google Scholar
  4. Barnat, M. R. (1986). Post-traumatic headache patients, I: Demographics, injuries, headache and health status. Headache 26: 271-277.Google Scholar
  5. Berrol, S. (1992). Terminology of post-concussion syndrome. Physical Medicine and Rehabilitation 6: 1-20.Google Scholar
  6. Binder, L. M. (1986). Persisting symptoms after mild head injury: A review of the postconsussive syndrome. Journal of Clinical and Experimental Neuropsychology 8: 323-346.Google Scholar
  7. Binder, L. M., and Rattock, J. (1989). Assessment of the postconcussive syndrome after mild head trauma. In Lezak, M. D. (ed.), Assessment of the Behavioral Consequences of Head Trauma, Liss, New York, pp. 37-48.Google Scholar
  8. Bohnen, N., Jolles, J., Twijnstra, A., Mellink, R., and Sulon, J. (1992). Coping styles, cortisol reactivity, and performance in a vigilance task of patients with persistent postconcussive symptoms after a mild head injury. International Journal of Neuroscience 64: 97-105.Google Scholar
  9. Bohnen, N., Twijnstra, A., and Jolles, J. (1992). Post-traumatic and emotional symptoms in difference subgroups of patients with mild head injury. Brain Injury 6: 481-487.Google Scholar
  10. Bond, M. (1984). The psychiatry of closed head injury. In Brooks, D. N. (Ed.), Closed Head Injury: Psychological, Social, and Family Consequences, Oxford University Press, Oxford, pp. 44-73.Google Scholar
  11. Busch, C. R., and Alpern, H. P. (1995). [Basal salivary cortisol levels in patients suffering from Postconcussion Syndrome]. Unpublished data.Google Scholar
  12. Cantu, R. C. (1992). Cerebral concussion in sport. Sports Medicine 14: 64-74.Google Scholar
  13. Couch, J. R., Jr. (1995). Post-concussion (post-trauma) syndrome. Journal of Neurological Rehabilitation 9: 83-89.Google Scholar
  14. Coyne, J. C. (1994). Self-reported distress: analog or ersatz depression. Psychological Bulletin 116: 29-45.Google Scholar
  15. Diamond, R., Barth, J. T., and Zillmer, E. A. (1988). Emotional correlates of mild closed head trauma: The role of the MMPI. The International Journal of Clinical Neuropsychology 10: 35-40.Google Scholar
  16. Dinan, T. G., and Mobayed, M. (1992). Treatment resistance of depression after head injury: A preliminary study of amitriptylnie response. Acta Psychiatrica Scandinavica 85: 292-294.Google Scholar
  17. Dikmen, S. S., and Levin, H. S. (1993). Methodological issues in the study of mild head injury. Journal of Head Trauma Rehabilitation 8: 30-37.Google Scholar
  18. Downhill, J. E. Jr., and Robinson, R. G. (1994). Longitudinal assessment of depression and cognitive impairment following stroke. Journal of Nervous Mental Disease 182: 425-431.Google Scholar
  19. Ettlin, T. M., Kischka, U., Reichmann, S., Radii, E. W., Heim, S., à Wengen, D., and Benson, D. F. (1992). Cerebral symptoms after whiplash injury of the neck: A prospective clinical and neuropsychological study of whiplash injury. Journal of Neurology, Neurosurgery, and Psychiatry 55: 943-948.Google Scholar
  20. Evans, R. W. (1996). The postconcussion syndrome and the sequelae of mild head injury. In Evans, R. W. (ed.), Neurology and Trauma, W. B. Saunders and Co., Philadelphia, PA, pp. 91-116.Google Scholar
  21. Fann, J. R., Katon, W. J., Uomoto, J. M., and Esselman, P. C. (1995). Psychiatric disorders and functional disability in outpatients with traumatic brain injuries. American Journal of Psychiatry 152: 1493-1499.Google Scholar
  22. Fedoroff, J. P., Starkstein, S. E., Forrester, A. W., Geisler, F. H., Jorge, R. E., Arndt, S. V., and Robinson, R. G. (1992). Depression in patients with acute traumatic brain injury. American Journal of Psychiatry 49: 918-923.Google Scholar
  23. Gasparrini, W. G., Satz, P.l., Heilman, K. M., and Coolidge, F. L. (1978). Hemispheric asymmetries of affective processing as determined by the Minnesota Multiphasic Personality Inventory. Journal of Neurology, Neurosurgery and Psychiatry 41: 470-473.Google Scholar
  24. Gasquione, P. G. (1992). Affect state and awareness of sensory and cognitive effects after closed head injury. Neuropsychology 6: 187-196.Google Scholar
  25. Gass, G. S. (1991). MMPI-2 interpretation and closed head injury: a correction factor. Psychological Assessment: A Journal of Consulting and Clinical Psychology 3: 27-3.Google Scholar
  26. Gennarelli, T. A. (1985, October). The state of the art of head injury biomechanics. Paper presented at the George C. Snively Memorial Lecture, Washington, DC.Google Scholar
  27. Gennarelli, T. A., Thibault, L. E., Adams, J. H., Graham, D. I., Thompson, C. J., and Marcincin, R. P. (1982). Diffuse axonal injury and traumatic coma in the primate. Annals of Neurology 12: 564-574.Google Scholar
  28. Gfeller, J. D., Chibnall, J. T., and Duckro, P. N. (1994). Postconcussion symptoms and cognitive functioning in posttraumatic headache patients. Headache 34: 503-507.Google Scholar
  29. Glazer, H. I., Clarkin, J. F., and Hunt, H. F. (1981). Assessment of depression. In Clarkin, J. F., and H. I. Glazer (eds.), Depression: Behavioral and Directive Intervention Strategies, Garland STPM Press, New York.Google Scholar
  30. Gotlib, I. H., and Hammen, C. L. (1992). Psychological Aspects of Depression, John Wiley and Sons, New York.Google Scholar
  31. Gotlib, I. H., and McCann, C. D. (1984). Construct accessibility and depression: an examination of cognitive and affective factors. Journal of Personality and Social Psychology 47: 427-439.Google Scholar
  32. Gouvier, W. D., Cubic, B., Jones, G., Brantely, P., and Cutlip, Q. (1992). Postconcussion symptoms and daily stress in normal and head-injured college populations. Archives of Clinical Neuropsychology 7: 193-211.Google Scholar
  33. Gronwall, D., and Wrightson, P. (1975, Nov. 22). Cumulative effect of concussion. Lancet, pp. 995-997.Google Scholar
  34. Gronwall, D., and Wrightson, P. (1981). Memory and information processing capacity after closed head injury. Journal of Neurology, Neurosurgery and Psychiatry 44: 889-895.Google Scholar
  35. Gualtieri, C. T. (1995). The problem of mild brain injury. Neurpsychiatry, Neuropsychology, and Behavioral Neurology 8: 127-136.Google Scholar
  36. Guthkelch, A. N. (1980). Post-traumatic amnesia, post-concussional symptoms and accident neurosis. Europeian Neurology 19: 91-102.Google Scholar
  37. Hamm, R. J., Pike, B. R., Temple, M. D., O'Dell, D. M., and Lyeth, B. G. (1995). The effect of postinjury kindled seizures on cognitive performance of traumatically brain injured rats. Experimental Neurology 136: 143-148.Google Scholar
  38. Harrington, K. T., and Harrington, D. E. (1993). Definition of mild traumatic brain injury. Journal of Head Trauma Rehabilitation 8: 86-87.Google Scholar
  39. Heller, W. (1993). Gender differences in depression: perspectives from neuropsychology. Journal of Affective Disorders 29: 129-143.Google Scholar
  40. Jenkins, A., Teasdale, G., Hadley, M. D. M., MacPherson, P., and Rowan, J. O. (1986). Brain lesions detected by magnetic resonance imaging in mild and severe head injuries. Lancet 2: 445-446.Google Scholar
  41. Jennett, B., and Teasdale, G. (1981). Management of Head Injuries. F. A. Davis, Philadelphia, PA.Google Scholar
  42. Jorge, R. E., Robinson, R. G., and Arndt, S. (1993). Are there symptoms that are specific for depressed mood in patients with traumatic brain injury? The Journal of Nervous and Mental Disease 181: 91-99.Google Scholar
  43. Jorge, R. E., Robinson, R. G., Arndt, S. V., Starkstein, S. E., Forrester, A. W., and Geisler, F. (1993). Depression following traumatic brain injury: a 1 year longitudinal study. Journal of Affective Disorders 27: 233-243.Google Scholar
  44. Kay, T., Newman, B., Cavallo, M., Ezrachi, O., Resnick, M. (1992). Toward a neuropsychological model of functional disability after mild traumatic brain injury. Neuropsychology 6: 371-384.Google Scholar
  45. King, N. S. (1996). Emotional, neuropsychological, and organic factors: their use in the prediction of persisting postconcussion symptoms after moderate and mild head injuries. Journal of Neurology, Neurosurgery, and Psychiatry 61:75-81.Google Scholar
  46. Kinsella, G., Moran, C., Ford, B., and Ponsford, J. (1988). Emotional disorder and its assessment within the severe head-injured population. Psychological Medicine 18: 57-63.Google Scholar
  47. Lee, S. T., and Lui, T. N. (1992). Early seizures after mild closed head injury. Journal of Neurosurgery 76: 435-439.Google Scholar
  48. Leininger, B. E., Kreutzer, J. S., and Hill, M. R. (1991). Comparison of minor and severe head injury emotional sequelae using the MMPI. Brain Injury 5: 199-205.Google Scholar
  49. Levin, H. S., Amparao, E., Eisenberg, J. M., Williams, D. H., High, W. M., Jr., McArdle, C. B., and Weiner, R. L. (1987). Magnetic resonance imaging and computerized tomography in relation to the neurobehavioral sequelae of mild and moderate head injures. Journal of Neurosurgery 66: 706-713.Google Scholar
  50. Levin, H. S., Benton, A. L., and Grossman, R. G. (1982). Neurobehavioral Consequences of Closed Head Injury, Oxford Press, New York.Google Scholar
  51. Levin, H. S., Grafman, J., and Eisenberg, H. M. (Eds.). (1987). Neurobehavioral Recovery from Head Injury, Oxford Press, New York.Google Scholar
  52. Lewinsohn, P. M., and Teri, L. (1982). Selection of depressed and non-depressed subjects on the basis of self-report data. Journal of Consulting and Clinical Psychology 50: 590-591.Google Scholar
  53. Lezak, M. D. (1978). Subtle sequelae of brain damage. Perplexity, distractibility and fatigue. American Journal of Physical Medicine 57: 9-15.Google Scholar
  54. Lishman, W. A. (1973). The psychiatric sequelae of head injury: A review. Psychological Medicine 3: 304-318.Google Scholar
  55. Lister, R. G. (1985). The amnestic action of benzodiazepines in man. Neuroscience and Behavior Reviews 9: 87-94.Google Scholar
  56. MacNiven, E., and Finlayson, M. A. J. (1993). The interplay between emotion and cognitive recovery after closed head injury. Brain Injury 7: 241-246.Google Scholar
  57. Mas, F., Prichep, L. S., and Alper, K. (1993). Treatment resistant depression in a case of minor head injury: an electrophysiological hypothesis. Clinical Electroencephalography 24: 118-122.Google Scholar
  58. McAllister, R. W. (1992). Neuropsychiatric sequelae of head injuries. Psychiatric Clinics of North America 15: 395-413.Google Scholar
  59. McBeath, J. G., and Nanda, A.N. (1994). Use of dihydroergotamine in patients with postconcussion syndrome. Headache 34: 148-151.Google Scholar
  60. Merskey, H. (1996). Psychiatric aspects of the neurology trauma. In Evans, R. W. (ed.) Neurology and Trauma, W. B. Saunders and Co., Philadelphia, PA.Google Scholar
  61. Mialet, J.-P., Pope, H. G., and Yurgelun-Todd, D. (1996). Impaired attention in depressive states: a non-specific deficit? Psychological Medicine 26: 1009-1020.Google Scholar
  62. Miller, L. (1993). Psychotherapy of the Brain-Injured Patient, W. W. Norton, New York.Google Scholar
  63. Mittenberg, W., Zielinski, R., and Fichera, S., (1993). Recovery from mild head injury: A treatment manual for patients. Psychotherapy in Private Practice 12: 37-52.Google Scholar
  64. Mobayed, M., and Dinan, T. G. (1990). Buspirone/prolactin response in post head injury depression. Journal of Affective Disorders 19: 237-241.Google Scholar
  65. Nockleby, D. M., and Deaton, A. V. (1984). Denial versus distress: coping patterns in post head trauma patients. Journal of Neurology, Neurosurgery, and Psychiatry 47: 260-268.Google Scholar
  66. Nolen-Hoeksma, S. (1990). Sex Differences in Depression, Stanford University Press, Stanford, CA.Google Scholar
  67. Novack, T. A., Daniel, M. S., and Long, C. J. (1984). Factors related to emotional adjustment following head injury. International Journal of Clinical Neuropsychology 6: 139-142.Google Scholar
  68. O'Carroll, R. E., Woodrow, J., and Maroun, F. (1991). Psychosexual and psychosocial sequelae of closed head injury. Brain Injury 5: 303-313.Google Scholar
  69. O'Hara, C. (1988). Emotional adjustment following minor head injury. Cognitive Rehabilitation 6: 26-33.Google Scholar
  70. Ommaya, A. K., and Gennarelli, T. A. (1974). Cerebral concussion and traumatic unconsciousness. Brain 97: 633-654.Google Scholar
  71. Oppenheimer, D. R. (1968). Microscopic lesions in the brain following head injury, Journal of Neurosugery and Psychiatry 31: 299-306.Google Scholar
  72. Parker, R. S., and Rosenblum, A. (1996). IQ loss and emotional dysfunctions after mild head injury incurred in a motor vehicle accident. Journal of Clinical Psychology 52: 32-43.Google Scholar
  73. Post, R. M., Rubinow, D. R., and Ballenger, J. C. (1984). Conditioning, sensitization, and kindling: Implications for the course of affective illness. In Post, R. M., and Ballenger, J. C. (eds.), Neurobiology of the Mood Disorders, Williams and Wilkins, Baltimore, MD.Google Scholar
  74. Povlishock, J. T., and Coburn, T. H. (1989). Morphopathological change associated with mild head injury. In Levin, H. S., Eisenberg, H. M., and Benton, A. L. (eds.), Mild Head Injury, Oxford University Press, New York, pp. 37-53.Google Scholar
  75. Povlishock, J. T., Becker, D. P., Cheng, C. L. Y., and Vaughn, G. W. (1983). Axonal degeneration induced by experimental non-invasive minor head injury. Journal of Neurosurgery 62: 96-100.Google Scholar
  76. Rimel, R. W., Giordani, B., Barth J. T., Boll, J. T., and Jane, J. (1981). Disability caused by minor head injury. Neurosurgery 9: 221-228.Google Scholar
  77. Robinson, R. G. (1986). Post-stroke mood disorders. Hospital Practice 21: 83-89.Google Scholar
  78. Robinson, R. G., and Starkstein, S. E. (1989). Mood disorders following stroke: new findings and future directions. Journal of Geriatric Psychiatry 22: 1-15.Google Scholar
  79. Rutherford, W. H. (1989). Postconcussion symptoms: Relationship to acute neurological indices, individual differences, and circumstances of injury. In Levin, H. S., Eisenberg, H. M., and Benton, A. L. (eds.), Mild Head Injury, Oxford University Press, New York, pp. 217-228.Google Scholar
  80. Rutherford, W. H., Merrett, J. D., and McDonald, J. R. (1977). Sequelae of concussion caused by minor head injuries. Lancet 1: 1-4.Google Scholar
  81. Saran, A. (1985). Depression after minor closed head injury: Role of dexamethasone suppression test and antidepressants. The Journal of Clinical Psychiatry 46: 335-338.Google Scholar
  82. Saran, A. (1988). Antidepressants not effective in headache associated with minor head injury. National Journal of Psychiatry in Medicine 18: 75-83.Google Scholar
  83. Schoenhuber, R., and Gentilini, M. (1988). Anxiety and depression after mild head injury: a case control study. Journal of Neurology, Neurosurgery, and Psychiatry 51: 722-724.Google Scholar
  84. Schoenhuber, R., Gentilini, M., and Orlando, A. (1988). Prognostic value of auditory brain-stem response for late postconcussion symptoms following minor head injury. Journal of Neurosurgery 68: 742-744.Google Scholar
  85. Sekino, H., Nakamura, N., Yuki, K., Satoh, J., Kikuchi, K., and Sanada, S. (1981). Brain lesions detected by CT scans in cases of minor head injury. Neurologica Medica Chirurgica 21: 677-683.Google Scholar
  86. Slagle, D. A. (1990). Psychiatric disorders following closed head injury: an overview of biopsychosocial factors in their etiology and management. International Journal of Psychiatry in Medicine 20: 1-35.Google Scholar
  87. Stauss, I., and Savitsky, N. (1934). Head injury: neurologic and psychiatric aspects. Archives of Neurological Psychology 31: 893-955.Google Scholar
  88. Stein, S. C. (1996). Classification of head injury. In Narayan, R. K., Wilberger, J. E., Jr., and Povlishock, J. T. (eds.), Neurotrama, McGraw-Hill, New York.Google Scholar
  89. Strich, S. J. (1961, Aug. 6). Shearing of nerve fibres as a cause of brain damage due to head injury: a pathological study of twenty cases. Lancet, 443-448.Google Scholar
  90. Sweeney, J. E. (1992). Nonimpact brain injury: grounds for clinical study of the neuropsychological effects of acceleration forces. The Clinical Neuropsychologist 6: 443-457.Google Scholar
  91. Syzmanski, H. V., and Linn, R. (1992). A review of the postconcussion syndrome. International Journal of Psychiatry in Medicine 22: 357-375.Google Scholar
  92. Tucker, G. J. (1994). DSM-IV: Proposed criteria for postconcussive disorder. Journal of Neuropsychiatry 6: 58-59.Google Scholar
  93. Tyler, G. S., McNeely, H. E., and Dick, M. L. (1980). Treatment of post-traumatic headache with amitriptyline. Headache 20: 213-216.Google Scholar
  94. Van Woerkom, T. C., Teelken, A. W., and Minderhoud, J. M. (1977). Difference in neurotransmitter metabolism in frontotemporal-lobe contusion and diffuse cerebral contusion. Lancet 1: 812-813.Google Scholar
  95. Verduyn, W. H., Hilt, J., Roberts, M. A., and Roberts, R. J. (1992). Multiple partial seizure-like symptoms following 'minor' closed head injury. Brain Injury 6: 245-260.Google Scholar
  96. Weighill, V. E. (1983). Compensation neurosis: A review of the literature. Journal of Psychosomatic Research 27: 97-104.Google Scholar
  97. World Health Organization (1978). Mental Disorders: Glossary and Guide to Their Classification in Accordance with the 9th Revision of the International Classification of Diseases. Geneva: WHO.Google Scholar

Copyright information

© Plenum Publishing Corporation 1998

Authors and Affiliations

  • Chardelle R. Busch
    • 1
  • Herbert P. Alpern
    • 1
  1. 1.Department of Psychology, Behavioral Neuroscience ProgramUniversty of ColoradoBoulder

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