Many people don’t consider how severely debilitating the cognitive outcomes of brain injury can be. Many families and friends perceive low mood as something someone will get over. They can underestimate the intense levels of work and enormity of effort that is need to overcome even ‘minor’ things when your brain doesn’t work and no longer supports you the way it used to.

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  • Introduction
  • Causes
  • Getting Signals Crossed
  • Paradoxes
  • Moving Forwards


There are many reasons why people become depressed following a brain injury, and while this is generally termed and thought of as an emotional outcome, many people associate to, and connect the many symptoms together, and think of their depression as being an overall ‘physical’ problem. Many see their emotions as being an outcome of their distress, rather than as the cause of it.

Depression can be experienced in very different ways; for some, it is debilitating, and for others, it is less so. It is a serious issue for everyone, as untreated symptoms can worsen and so too can the depth of depression felt. It is always best to seek early help.

Most people who have depression following a brain injury will have had support from a doctor and/or other health care professionals. In general, there is enough awareness that people do seek help before things deteriorate so badly that they begin to have thoughts about self-harming or suicidal tendencies.

Untreated depression is the number one cause for suicide and people who have sustained a brain injury are three times more likely to become depressed. People living with brain injury outcomes and symptoms are at a much higher risk of suicide, not only due to depression but also due to the enormity of the struggle involved in understanding and managing the effects.


There can be many different causes of depression following a brain injury. 

The primary reasons are damage to the emotional control centre, and, the bio-chemical cascade that happens immediately after the initial injury occurs.

For some, there can be an exacerbation of previous tendencies or an increase in existent stress.

Many other factors will contribute to the likelihood of depression occurring, and these include, sleep problems/insomnia, poor nutrition, poor or existing health issues, vitamin or mineral deficiencies, food intolerances, imbalances in gut flora, and alcohol or drug abuse. Environmental toxins and food additives can also increase difficulty with managing emotions.

As far as research goes, at present, there is no defined cause of depression following a brain injury.

Getting signals crossed

Because of the common cognitive effects of brain injury, such as difficulty with slowed processing and filtering incoming information, maintaining attention and a multitude of other outcomes, people can sometimes confuse symptoms with depression.

This confusion arises due to many of the symptoms ‘matching’ those you would find listed for depression, such as sleep problems, fatigue, poor concentration, lack of interest in doing anything, a lack of energy and confusion.

It can be challenging to interpret and understand or recognise the impetus for thoughts following brain injury, so we may not be aware that there are mismatches in thinking. Because a lot of fundamental data can be lost, people are often unaware of this.

This confusion can also happen when there is a lack of information given at the outset. For example, if you don’t know that sleep problems are a common outcome of brain injury, you may try and think of other causes.


Because there can be some difficulty with processing following a brain injury many people struggle with reaching conclusions, knowing how to modify or improve their thoughts, or making decisions.

It is possible to get stuck at ‘thought A’ and believe this is the sum of it all when in reality, the full answer lays another five steps up the track. If you aren’t aware of the possibility of thought ‘B’ existing, then you stand no chance of getting to the final destination of step five, thought ‘E.’

When our thoughts get stuck due to executive dysfunction, it is possible to get trapped in ‘all-or-nothing’ thinking wherein we are unable to see other possibilities or perspectives.

If you are unaware that these outcomes are common, because of a lack of information and support, you may struggle for years wondering why so many things go wrong. When we have the awareness that things can go wrong if we haven’t thought them through properly, we have the mindfulness to pre-prepare or to possibly revisit a situation at the juncture things went wrong. These skills are often missing following a brain injury.

After a brain injury, you may simply no longer know how to break thoughts down (another cognitive skill) to be able to understand them, and you may no longer know how to rebuild them in a meaningful way.

An inability to break thoughts down often happens to people after they have been through both a traumatic experience and a brain injury – there is a lot of emotion and information to sort out in the aftermath.

Other problems that will interfere with this process are memory problems, loss of experiential memories, and factors such as denial where we are not ready emotionally to address things.

We may think that it is depression, anxiety, or PTS/GAD/PTSD that are at the basis for our inability to stop thoughts perpetuating a vicious circle, when in fact, it is often the physical, cognitive and biochemical changes that are interfering with our ability to think – especially in cases of more severe injury.

The ambiguity caused by neurological damage can make it hard for people to understand the exact nature of what is troubling them.

For example, you may only be able to express that you feel sad, and be unable to understand, or tell anyone else, why. You may feel unable to cope and not realise that you have low self-esteem. You may feel anger and despite trying to think about why you never get any answers back from your brain. This ambiguity can cause people to think they are in denial instead of realising you aren’t asking the right, or in-depth enough, questions.

Seeing a list of possible reasons that could lay behind your confusion can help. It can help you break things down and help you to know where to start.

  • loss of dreams

  • low self-esteem

  • doubting your trust in others

  • feeling unaccepted friends who don’t stick around – feeling abandoned

  • lost leisure pursuits

  • sense of loss feelings of isolation/loneliness

  • disappointment

  • guilt

  • loss of trust in yourself

  • unresolved abuse

  • ambiguous loss

  • feeling like a burden

  • loss of independence

  • anger from lack of acceptance self – or others

  • unable to contribute

  • loss of feeling responsible / responsibilities

These are examples; not a definitive list.

Moving forwards

If you have severe depression or self-harm/suicidal thoughts, you must never attempt to try and deal with it alone, assume or hope it will go away or try to fix things without specialist medical supervision. You should always seek urgent medical assistance.

If you have recently had a brain injury but have not had a formal diagnosis – please speak to your doctor first. If you are worried about remembering what to say print this document and take it with you – Brain Injury A Guide for General Practitioners – Click To Print / Download

If you have recently suffered a concussion and feel depressed, this could be due to clinical depression, and you should consult with your doctor.

‘Strategies for improving brain injury outcomes‘ are intended for those who are dealing with cognitive outcomes – they are not a way to deal with clinical depression. These strategies will help you to be able to learn methods to break down your confusions, understand it and put it back together in ways that will help you. Before attempting any self-help, you should speak to your doctor. There may be issues that you are unaware of or underlying medical causes.

Clear this with your doctor first. Please see our disclaimer and Terms and Conditions