Head Injuries, Depression & Suicide

Traumatic brain injury and chronic traumatic encephalopathy can have negative effects on mood

/ Author:  / Reviewed by: Robert Carlson, M.D

Concussions don’t have to knock a person out cold to cause brain damage. A couple of good tackles in a contact sport can cause damage that can affect a person’s ability to process emotions and information later in life. 

Even mild traumatic brain injuries (TBI) that show no signs of structural damage whatsoever, are no laughing matter; chronic traumatic encephalopathy (CTE) is a long-term result of one or more mild or moderate TBI.

Both neurological disruptions are causing depression, anxiety and increased risk of suicide in athletes and soldiers.

Implementation of prevention methods, better designs in helmets and greater awareness are all going to be necessary to lower the rates of these two very real problems.

Chronic Traumatic Encephalopathy & Traumatic Brain Injury

TBI can be mild, moderate or severe. Any non-topical head injury can be a TBI - from a light concussion to a bullet entering the brain. When a person experiences TBI, even mild TBI where they never lose consciousness, they are at risk for developing CTE in the future.

By definition of the Center for the Study of Traumatic Encephalopathy, CTE is defined as: “[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 subconcussive hits to the head.

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.”

According to a study led by Dr. Shaheen E. Lakhan, MD, PhD, from the Global Neuroscience Initiative Foundation somewhere between 100,000 and 300,000 concussions affect American football players every single year. Not all of them are even detected, as it is not necessary to ‘black out’ to have experienced a concussion.

A couple of ‘dings’ can contribute to the progressive neurodegenerative damage that may go completely unnoticed until several years later when the proteins build up and cause the symptoms discussed above.

Explosions in the Line of Duty

Military personnel exposed to blasts are showing evidence of CTE from TBI. Researchers from the Center for the Study of Traumatic Encephalopathy at the Boston University School of Medicine and in association with the Veterans Affairs Boston Healthcare System autopsied the brains of US military personnel to see how the incidence of improvised explosive devices (IED) damaged the brain tissue of soldiers. CTE can only be properly diagnosed via autopsy.

The presence of tau proteins is the definitive diagnostic evidence of CTE and can only be verified by dissecting the brain.

Dr. Lee Goldstein MD, PhD, and Dr. Ann McKee, co-authors of the study estimate that somewhere around 20 percent of the 2.3 million U.S. military personnel that have been deployed since 2001 have been exposed to an explosive blast great enough to cause TBI.

Doctors Goldstein and McKee autopsied blast-exposed military personnel along with football players and a professional wrestler, and included uninjured brains for comparison. The blast-exposed military personnel and the athletes all shared similar CTE pathology in their brains.

“Our results showed that the neuropathy from blast exposure, concussive injury, or both were virtually indistinguishable from those with a history of repeat concussive injury,” according to Dr. McKee.

This means that athletes playing full contact sports can have brains that look like that of soldiers who have been knocked down by an IED.

At the Montgomery Veterans Affairs Medical Center in Mississippi, Dr.’s Roy Reeves, DO, PhD, and Janet Laizer, MD, did a study on the TBI outcomes. In the study, they state that TBI in soldiers is actually increasing because of better body armor.

Technological advancements in chest and body armor are saving the lives of soldiers that would have died from chest wounds in previous wars.

Head and neck protection have not come as far, so soldiers can live after being bombed with an IED because they don’t bleed out, but they’re going to live with the results of TBI that may not be detected due to a lack of structural damage.

Sports Related Injuries

There are a lot of sports commonly played by children, adolescents and adults alike where the unfortunate side-affect of concussions, mild, moderate and severe, occur on a daily basis.

The term ‘punch-drunk’ has been used since before World War II to describe boxers who looked like they were ‘drunk’ on alcohol, but were really exhibiting signs of brain damage from repeated blows to the head—CTE. Now scientists are seeing that boxers aren’t the only athletes at risk for appearing ‘punch-drunk’.

In an editorial in the Canadian Medical Association Journal, Dr. Rejendra Kale, MD, writes about hockey player’s risk for CTE. Famous players Rick Martin, Reggie Fleming, Derek Boogaard and Bob Probert all had their brains autopsied upon their deaths at the Center for the Study of Traumatic Encephalopathy at Boston University.

52 more ‘concerned’ National Hockey League (NHL) players that are still alive have already signed up to have their brains autopsied as well to determine if they, too, have the tau proteins that indicate CTE.

Dr. Kale’s editorial was a call-to-action to impose a no-fighting rule in the NHL, sparked by a class action lawsuit if necessary.

Class Action Lawsuit Against the NFL

Philadelphia based attorney, Craig Mitnick, represents numerous retired NFL players who filed a class action lawsuit against the NFL for keeping the medical truth about TBI and their head injuries from them during their careers.

Former Philadelphia Eagles: Ron Solt, Joe Panos, Rich Miano, Gennaro DiNapoli, Adam Haayer, Craig Heimburger and several others have banded together under the claim that the NFL knowingly deceived the players about their head injuries to get them to keep playing football.

A couple of months after the lawsuit was filed, the suicide of NFL linebacker Junior Seau brought further attention to the potential for suicide as a result of TBI and/or CTE. Mitnick stated, “A lot of athletes I’m speaking with after Junior Seau’s incident are saying, ‘Wow, I’m glad I joined this. I need to become part of this. I’m worried. I have some symptoms.”

NFL safety, Ray Easterling, committed suicide 11 days before Seau. Easterling had been involved in filing suit against the NFL for concussion-related injuries before his death.

Dave Duerson, who played for the Chicago Bears, left a note when he took his own life that requested his brain be donated to Boston University Center for the Study of Traumatic Encephalopathy. Researchers did determine Deurson had CTE.

The Science of TBI & Suicide

In a study done by the School of Psychology and Psychiatry at Monash University, Dr. Jennie Ponsford, PhD, and her colleagues were able to determine the causality of fatigue and sleep trouble following TBI: “anxiety, depression and pain”.

Dr. Ponsford’s study also claims that: “fatigue is also associated with slowed information processing and the need for increased effort in performing tasks.”

Dr.’s Reeves and Laizer claim that: “TBI is a leading cause of death and disability. In the United States, approximately 230,000 people experience TBI annually, making the disorder a serious health problem.”

Based on the research that they compiled, 8.9 percent of patients with TBI attempt suicide, while only 1.9 percent of the normal population attempts to commit suicide.

There is hope with TBI and CTE. There is no magic bullet to treat or cure the depressive symptoms resulting from head injuries, but information and awareness can slow the causes.

Better headgear for soldiers and athletes, therapy, mood stabilizers and sleep aids, and most importantly the cessation of unnecessary risks and unsafe practices in athletics can all be combined to significantly lower this all too common public health problem.

Reviewed by: 
Review Date: 
May 28, 2012