It is important to get treatment for depression as soon as symptoms are recognized to prevent needless suffering and worsening symptoms. The good news is that antidepressant medications and psychotherapy (counseling), or a combination of the two, can help most people with depression. Many people do best with a combination of approaches. Our research team has been exploring which treatment approaches are the most acceptable and effective for people with traumatic brain injury and depression.
For many people, there may be considerable barriers to getting adequate mental health services. For people with traumatic brain injury, barriers to treatment may be even greater and include:
- difficulty coordinating care for multiple medical and psychological problems
- transportation limitations (e.g. cost, distance, inability to drive because of medical limitations such as seizures)
- avoidance of trauma-focused components of mental health care
- motivational (ambivalence), behavioral, cognitive, social and financial problems that interfere with a person’s ability to attend scheduled appointments
Research has found that depression is under-treated in people with TBI. Less than half of those with TBI and major depression receive antidepressants or counseling during the first year after injury. Among those who receive treatment, it is unknown how many receive what is considered to be an adequate level of treatment. However, we know that in primary care, only 25% of depressed patients receive adequate depression treatment.
Patient Preferences in Depression Care
Patients should play an active role in choosing treatment for depression. Closely matching treatment preferences with provided care can lead to better treatment adherence and outcomes. For example, while some patients strongly prefer counseling over taking an antidepressant medication, others may prefer taking an antidepressant. Fortunately, there are a growing number of available and effective treatment approaches and delivery methods, such as receiving counseling over the telephone or the Internet. Health care providers should strive to educate patients about the pros and cons of the available treatment options so that a mutually agreed upon strategy can be reached.
- Approaches such as exercise, acupuncture and biofeedback have demonstrated to be helpful for some people in treating depression in the general population, and they may benefit individuals with traumatic brain injury. A professional specializing in traumatic brain injury should be consulted about these treatments.
- Treating anxiety and pain that may accompany depressive symptoms can also help to reduce depression.
- Brain injury support groups may be a good source of additional information and support for addressing depression and other challenges following a traumatic brain injury.