Posts Tagged Depression

[BLOG POST] Alcohol Use After a Brain Injury

I’ve never been what I would consider to be a heavy drinker, but I must admit that I have always enjoyed sharing a few drinks with family and friends. With summer on the horizon and day light extending once again in New Zealand, social gatherings will no doubt be occurring more frequently. For some, that translates in an increased likelihood of sharing a drink as well. Although my Weird Wonderful Brain can’t handle social gatherings really well anymore, I still make an effort to join in whenever I can. Apart from the usual brain injury challenges linked to social gatherings, there is another aspect that I need to consider…alcohol or alcohol free? 

It is an accepted custom in our society to have social drinks and a part of me really enjoys getting in on the bandwagon too. However, since encephalitis and brain injury, I have avoided consuming any amount of alcohol. There are a few reasons for this. Firstly, I feel spaced out most of the time so it tends to make things like following a conversation or simply keeping my balance much harder. On top of the heighten cognitive deficits, I have also noticed that on the rare occasions where I have consumed 2-3 drinks (which is still not a huge amount), the resulting physical effects have been pretty drastic. Alcohol seems to trigger my heart rate to increase considerably, I get loads of ectopic heart beats, I can feel extremely nauseous, I sweat profusely, it can trigger massive headaches and my tummy seems to get all tangled up.

I found that the cognitive and physical effects of alcohol post brain injury last long after my last drink and will often carry on throughout the night…stopping Sandman from stealing me away for some very well deserved and necessary sleep. Once you add the lack of sleep on top of a social event and a few drinks, it doesn’t take too long for the brain to spiral out of control.

Effects of alcohol on the brain

That led me into conducting a bit of research about the  “effects of alcohol on the brain”. From past personal experience, most of us are aware that alcohol, even if consumed at a recreational level, can alter our senses, bodily functions and cognitive functioning. Although they are likely to be temporary effects, alcohol can indeed slow our reaction time, alter or thinking and decision making process, trigger a loss of inhibition, induce blurry vision, impair our memory, slur our speech, muck up our balance, coordination and mobility and when consumed in excess, alcohol can even trigger black outs and cause us to be sick. From that list of ways in which a brain is affected by alcohol, I can already identify several cross-overs with how my Weird Wonderful Brain has been affected by the acquired brain injury. Some of those effects are present in spite of me being alcohol free so I was keen to dig further to better understand how an injured brain is likely to be further impacted. 

Effects of alcohol on an injured brain

There are bits and pieces of information out there on brain injury and alcohol use, but to my surprise, there wasn’t a huge amount.  The sources that I found had a theme in common which is, because alcohol affects the central nervous system, people with a brain injury “are likely to experience even greater problems with alertness, memory, problem-solving, and controlling their behaviour and emotions.”[1]

I eventually landed on the MSKTC website which provides a very interesting fact sheet in regards to brain injury and alcohol use.  The following facts [2] were taken directly from their website and were the ones that resonated the most with me:

  • Alcohol slows down or stops brain injury recovery.
  • Not drinking is one way to give the brain the best chance to heal.
  • People’s lives often continue to improve many years after brain injury. Not drinking will increase the chance of improvement.
  • Not drinking can reduce the risk of developing seizures.
  • Drinking alcohol puts survivors at an even higher risk of having a second brain injury. This may be because both brain injury and alcohol can affect coordination and balance.
  • Not drinking can reduce the risk of having another brain injury.
  • Alcohol may affect brain injury survivors more than it did before their injury.
  • Alcohol magnifies some of the cognitive problems caused by brain injury.
  • Not drinking is one way to keep your mental abilities at their best and stay sharp and focused.

There was also very useful information relating to alcohol and depression.  It is proven that people suffering from a brain injury are already at a greater risk of developing a form of mental illness such as depression. Alcohol being a known depressant, it could also cause or worsen symptoms of depression. Therefore, keeping alcohol out of the equation could improve your chances of keeping depression at bay or at least improve your chances of better managing it. 

Post brain injury, you may also need to be aware of how alcohol can affect your current medication. In some cases, it can decrease or stop their effectiveness and in others, it may increase their effectiveness and potential side effects. It is therefore another aspect that needs to be weighted very carefully when making decisions regarding alcohol consumption post brain injury.

During my research, I unfortunately didn’t find much relating to how the consumption of alcohol by a brain injury survivor can impact the heart rate. However, once I took the words brain injury out of the equation,  I found many ways in which alcohol can affect the cardiovascular system e.g: increased heart rate, high blood pressure, weakened heart muscle and irregular heartbeat.[3] Although they aren’t symptoms that I experienced prior to my acquired brain injury, they are very much present now and it demonstrates clearly how my body’s tolerance to alcohol has been impacted…even if consumed at a very low level. I can only assume that the changes in my brain pathways following the encephalitis must have tweaked how the heart electrical system works…making me more prone to temporary arrhythmia perhaps? All I know is that it is an uneasy feeling to experience. I feel my heart pounding and racing in my chest and I can even hear my heart pulsing in my ears as if music was playing in the background…it makes me feel absolutely terrible.

What have I learnt?

From all my readings, it simply seems that a person living with a brain injury is generally more sensitive to alcohol. We generally have less tolerance to alcohol and are at greater risk of experiencing many of its undesirable side effects even if consumed in a much smaller quantity. The payback is also likely to last much longer compared to the average person given all the other factors that brain injury survivors have to take into consideration. Since encephalitis, I’ve had many friends ask questions regarding alcohol consumption and brain injury which I’m always more than happy to answer.  However, I’ve also heard the rare but insensitive comment “Oh aren’t you going to have a drink with us to celebrate such and such person’s birthday”…as if drinking alcohol was a way to show someone that you care, as if it was a must to have a great time. Sometimes I wish that people would remember that part taking in a social event already comes with additional challenges for me and that my brain is foggy enough in the best of times. However, I generally brush those comments off pretty easily…I’m happy to let them hold on to whatever perception they might have. Deep down, I know that the people who truly matter to me don’t care whether I share an alcoholic drink with them or not. The ones who truly care will simply appreciate me being there and that’s good enough for me.

The reality is that post brain injury, there are no level of alcohol consumption considered to be safe and given how my body reacted when I have attempted the occasional 2-3 glasses of wine, I have made the very personal decision to avoid going there. Every now and again I do miss the social aspect of it, I miss the frivolity of the old me. Like most things post encephalitis and brain injury, it is a balancing act I suppose so whenever I chose to have alcohol, I prefer to keep to the one drink. The impact of going over this amount outweighs the positive so I feel like it’s just not worth it for me. I’m not judgmental of those who carry on, I actually used to be one of those person, but I hope that this blog helps those who may be puzzled by my decision to gain a better understanding of the ramifications of alcohol use post brain injury.

[1]: Synapse

[2]: MSKTC

[3]: Alcohol Think Again


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[Abstract + References] Art as a Therapeutic Tool in Depressive Disorders: a Systematic Review of the Literature


Different alternative forms of therapy have been studied in relation to their applicability and effectiveness. The use of art therapy in the treatment of depressive disorder is an example frequently employed in several countries. The aim of this research was to identify and discuss which artistic techniques have been applied most frequently in the treatment of depressive disorders and what their main effects are. The research was conducted in the MEDLINE/PubMed, American Psychological Association (APA) and Web of Science databases. The articles were selected through the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA protocol). 14 articles were selected, among which the main techniques of art therapy used were: manual work (drawing, painting, and modeling), music, poetry, photography, theater and contemplation of art pieces. It was found that most of the researches are European and as a field of knowledge they depart mainly from medicine. Of the 14 researches of this review, only two failed in the use of art therapy techniques as a therapeutic tool. It can be understood that art therapy is a safe and reliable tool for treatment not only of depression but also of other mental disorders.


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[Abstract] YouTube as a Source of Information for Transcranial Magnetic Stimulation in Stroke: A Quality, Reliability and Accuracy Analysis


•TMS is used to treat various diseases such as stroke and depression.

•Patients may be at risk of exposure to false information about TMS on YouTube.

•It is necessary to access the accurate information on YouTube about TMS treatment.

•Academicians need to be encouraged to create videos with better educational quality.


Background and objectives

Studies using YouTube data for various diseases are rapidly increasing. This study aimed to investigate the educational quality, reliability and accuracy of the YouTube videos concerning repetitive transcranial magnetic stimulation (rTMS) applications in patients with stroke.


This is a descriptive study. A video based search on YouTube was performed on April 18th, 2020 by using keyword ‘stroke repetitive transcranial magnetic stimulation’. The videos were queried using the default settings on YouTube and the results were listed according to relevance. Video parameters and sources were recorded. Quality, reliability and accuracy of the videos were determined with Global Quality Score (GQS), Journal of American Medical Association (JAMA) Benchmark Criteria and Modified DISCERN Questionnaire, respectively.


A total of 21 videos were included in the study. The median number of views for videos was 884 (range: 89-28589) and the median duration was 135 seconds. None of the videos had a negative interaction index. The median value was found to be 3 for all three measurements (GQS, JAMA, and DISCERN). Most of the videos were of intermediate quality (47.6%) and had partial sufficient data (61.9%). In the high-quality group, the number of views, dislikes, the duration of the videos, JAMA and DISCERN scores were higher than the low-quality group (p < 0.05). At the same time, viewing rates of the high-quality group were better than the low and the intermediate-quality group (p < 0.05). There was a significant positive correlation between GQS and number of the views, video duration, number of likes, number of dislikes, viewing rate and modified DISCERN questionnaire scores (p < 0.05).


Our results showed that most of the rated videos were of intermediate quality and had partially sufficient data. It has also been found that high-quality videos have higher viewing rates, more dislikes, longer video durations as well as better reliability and accuracy scores. YouTube videos of higher quality and accuracy are needed to increase awareness of rTMS by stroke patients.


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[VIDEO] 2019 Research about Transcranial Magnetic Stimulation TMS | NYC Psychiatrist – YouTube

Psychiatrist Robert D. McMullen – NYC – Depression Specialist – TMS BrainCare

In this video, we introduce Robert D. McMullen, MD who is a psychiatrist in NYC who has been performing psychopharmacology for over 30 years, the last 10 of which includes transcranial magnetic stimulation(TMS). Today, he will discuss some recent developments in research regarding TMS.

There were recently two conferences held in Vancouver, Canada regarding TMS research. The first was a 2 day conference held by the Clinical Society of TMS, which is the U.S organization for TMS research that has been around for 10 years. The second was the three day International Brain Stimulation held every 2 years. During these conferences, new research on TMS was presented.

Usually TMS treatments have been left excitatory on the left dorsolateral prefrontal cortex. It was then observed that if you performed inhibitory treatment on the right side it worked as well. Afterwards, many started doing bilateral treatments. Recent studies suggest that all those forms of treatment work equally as well, although for some, bilateral treatment might work better.

Another breakthrough in TMS treatment in the last few years is theta burst stimulation. It shortens the length of treatment on both sides of the brain(40 seconds on the right and 3 minutes and 8 seconds on the left side).

Recent findings suggest that doing 2 TMS treatments per day increases the odds of patients responding to TMS treatments. One recent study shows that people who receive 2 treatments per day for 15 days did just as well as people who did 1 treatment per day for 30 days. Using theta bursts significantly lowers the length of the treatment allowing multiple treatments to be performed in one day. Ideally, each treatment should be performed 15 minutes apart for optimal effect.

These were just a few of the findings presented at the conferences. Although TMS research is still ongoing, the future is looking bright for this method of treatment.

To learn more:

Psychiatrist Robert D. McMullen – NYC – Depression Specialist – TMS BrainCare

Location 1: 171 W 79th St #2, New York, NY 10024

Location 2: 344 Main St, Mt Kisco, NY 10549 Phone: 212 362-9635

TMS BrainCare

Address: #2, 171 W 79th St, New York, NY 10024

Phone: (212) 362-9635

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[Factsheet] Emotional Problems After Traumatic Brain Injury – MSKTC

On this page:

A brain injury can change the way people feel or express emotions. An individual with TBI can have several types of emotional problems.

Difficulty controlling emotions or “mood swings”

Some people may experience emotions very quickly and intensely but with very little lasting effect. For example, they may get angry easily but get over it quickly. Or they may seem to be “on an emotional roller coaster” in which they are happy one moment, sad the next and then angry. This is called emotional lability.

What causes this problem?

  • Mood swings and emotional lability are often caused by damage to the part of the brain that controls emotions and behavior.
  • Often there is no specific event that triggers a sudden emotional response. This may be confusing for family members who may think they accidentally did something that upset the injured person.
  • In some cases the brain injury can cause sudden episodes of crying or laughing. These emotional expressions or outbursts may not have any relationship to the way the persons feels (in other words, they may cry without feeling sad or laugh without feeling happy). In some cases the emotional expression may not match the situation (such as laughing at a sad story). Usually the person cannot control these expressions of emotion.

What can be done about it?

  • Fortunately, this situation often improves in the first few months after injury, and people often return to a more normal emotional balance and expression.
  • If you are having problems controlling your emotions, it is important to talk to a physician or psychologist to find out the cause and get help with treatment.
  • Counseling for the family can be reassuring and allow them to cope better on a daily basis.
  • Several medications may help improve or stabilize mood. You should consult a physician familiar with the emotional problems caused by brain injury.

What family members and others can do:

  • Remain calm if an emotional outburst occurs, and avoid reacting emotionally yourself.
  • Take the person to a quiet area to help him or her calm down and regain control.
  • Acknowledge feelings and give the person a chance to talk about feelings.
  • Provide feedback gently and supportively after the person gains control.
  • Gently redirect attention to a different topic or activity.


Anxiety is a feeling of fear or nervousness that is out of proportion to the situation. People with brain injury may feel anxious without exactly knowing why. Or they may worry and become anxious about making too many mistakes, or “failing” at a task, or if they feel they are being criticized. Many situations can be harder to handle after brain injury and cause anxiety, such as being in crowds, being rushed, or adjusting to sudden changes in plan.

Some people may have sudden onset of anxiety that can be overwhelming (“panic attacks”). Anxiety may be related to a very stressful situation— sometimes the situation that caused the injury—that gets “replayed” in the person’s mind over and over and interferes with sleep (“post traumatic stress disorder”). Since each form of anxiety calls for a different treatment, anxiety should always be diagnosed by a mental health professional or physician.

What causes anxiety after TBI?

  • Difficulty reasoning and concentrating can make it hard for the person with TBI to solve problems. This can make the person feel overwhelmed, especially if he or she is being asked to make decisions.
  • Anxiety often happens when there are too many demands on the injured person, such as returning to employment too soon after injury. Time pressure can also heighten anxiety.
  • Situations that require a lot of attention and information-processing can make people with TBI anxious. Examples of such situations might be crowded environments, heavy traffic or noisy children.

What can be done about anxiety?

  • Try to reduce the environmental demands and unnecessary stresses that may be causing anxiety.
  • Provide reassurance to help calm the person and allow them to reduce their feelings of anxiety when they occur.
  • Add structured activities into the daily routine, such as exercising, volunteering, church activities or self-help groups.
  • Anxiety can be helped by certain medications, by psychotherapy (counseling) from a mental health professional who is familiar with TBI, or a combination of medications and counseling.


Feeling sad is a normal response to the losses and changes a person faces after TBI. Feelings of sadness, frustration and loss are common after brain injury. These feelings often appear during the later stages of recovery, after the individual has become more aware of the long-term situation. If these feelings become overwhelming or interfere with recovery, the person may be suffering from depression.

Symptoms of depression include feeling sad or worthless, changes in sleep or appetite, difficulty concentrating, withdrawing from others, loss of interest or pleasure in life, lethargy (feeling tired and sluggish), or thoughts of death or suicide.

Because signs of depression are also symptoms of a brain injury itself, having these symptoms doesn’t necessarily mean the injured person is depressed. The problems are more likely to mean depression if they show up a few months after the injury rather than soon after it.

What causes depression?

  • Depression can arise as the person struggles to adjust to temporary or lasting disability and loss or to changes in one’s roles in the family and society caused by the brain injury.
  • Depression may also occur if the injury has affected areas of the brain that control emotions. Both biochemical and physical changes in the brain can cause depression.

What can be done about depression?

  • Anti-depressant medications, psychotherapy (counseling) from a mental health professional who is familiar with TBI, or a combination of the two, can help most people who have depression.
  • Aerobic exercise and structured activities during each day can sometimes help reduce depression.
  • Depression is not a sign of weakness, and it is not anyone’s fault. Depression is an illness. A person cannot get over depression by simply wishing it away, using more willpower or “toughening up.”
  • It is best to get treatment early to prevent needless suffering. Don’t wait.

Temper outbursts and irritability

Family members of individuals with TBI often describe the injured person as having a “short fuse,” “flying off the handle” easily, being irritable or having a quick temper. Studies show that up to 71% of people with TBI are frequently irritable. The injured person may yell, use bad language, throw objects, slam fists into things, slam doors, or threaten or hurt family members or others.

What causes this problem?

Temper outbursts after TBI are likely caused by several factors, including:

  • Injury to the parts of the brain that control emotional expression.
  • Frustration and dissatisfaction with the changes in life brought on by the injury, such as loss of one’s job and independence.
  • Feeling isolated, depressed or misunderstood.
  • Difficulty concentrating, remembering, expressing oneself or following conversations, all of which can lead to frustration.
  • Tiring easily
  • Pain

What can be done about temper problems?

  • Reducing stress and decreasing irritating situations can remove some of the triggers for temper outbursts and irritability.
  • People with brain injury can learn some basic anger management skills such as self-calming strategies, relaxation and better communication methods. A psychologist or other mental health professional familiar with TBI can help.
  • Certain medications can be prescribed to help control temper outbursts.

Family members can help by changing the way they react to the temper outbursts:

  • Understand that being irritable and getting angry easily is due to the brain injury. Try not to take it personally.
  • Do not try to argue with the injured person during an outburst. Instead, let him or her cool down for a few minutes first.
  • Do not try to calm the person down by giving in to his or her demands.
  • Set some rules for communication. Let the injured person know that it is not acceptable to yell at, threaten or hurt others. Refuse to talk to the injured person when he or she is yelling or throwing a temper tantrum.
  • After the outburst is over, talk about what might have led to the outburst. Encourage the injured person to discuss the problem in a calm way. Suggest other outlets, such as leaving the room and taking a walk (after letting others know when he/she will return) when the person feels anger coming on.

Questions to ask your physician or treatment provider to better understand your problem

If you or your family members are experiencing anxiety, feelings of sadness or depression, irritability or mood swings, consider asking your doctor:

  • Would psychological counseling be helpful?
  • Would an evaluation by a psychiatrist be helpful?
  • Are there medications that can help?

More about medications

If you or your family member tries a medication for one of these problems, it is very important to work closely with the physician or other health care provider who prescribes them. Always make a follow-up appointment to let him or her know how the medication is working, and report any unusual reactions between appointments. Remember that:

  • There can be a delay until the beneficial effects of medications are felt.
  • Doses might need to be adjusted by your doctor for maximum benefit.
  • You may need to try one or more different medications to find the one that works best for you.
  • Except in an emergency, you should not stop taking a prescribed medication without consulting your doctor.

Peer and other support

Remember, too, that not all help comes from professionals! You may benefit from:

  • A brain injury support group — some are specialized for the person with TBI, others are for family members, and others are open to everyone affected by brain injury.
  • Peer mentoring, in which a person who has coped with brain injury for a long time gives support and suggestions to someone who is struggling with similar problems.
  • Check with your local Brain Injury Association chapter to find out more about these resources. Go to to find brain injury resources near you.
  • Talk to a friend, family member, member of the clergy or someone else who is a good listener.

Recommended Reading

  • Living with Brain Injury: A Guide for Families, Second Edition (Paperback) by Richard C Senelick and Karla Dougherty, Healthsouth Press, 2001.
  • Making Life Work After Head Injury: A Family Guide for Life at Home. Author: South Carolina, Head and Spinal Cord Injury Division, and National Head Injury Foundation (U.S.), Florida Association. Publisher: S.C. Dept. of Disabilities and Special Needs, Head and Spinal Cord Injury Division, 1994.
  • What is Brain Injury? Emotional / Behavioral Changes, Toronto Acquired Brain Injury Network.
  • Emotional Stages in Recovery – Fact Sheet. Brain Injury Association of Queensland, Inc.


Emotional Problems after TBI was developed by Tessa Hart, PhD and Keith Cicerone, PhD, in collaboration with the Model Systems Knowledge Translation Center.

Portions of this document were adapted from materials developed by the UAB TBI Model System, the Mayo Clinic TBI Model System, the New York TBI Model System, the Carolinas Rehabilitation and Research System, and from Picking up the Pieces after TBI: A Guide for Family Members, by Angelle M. Sander, PhD, Baylor College of Medicine (2002).

Source: Our health information content is based on research evidence whenever available and represents the consensus of expert opinion of the TBI Model Systems directors.

Disclaimer: This information is not meant to replace the advice from a medical professional. You should consult your health care provider regarding specific medical concerns or treatment.

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[ARTICLE] Depression impedes neuroplasticity and quality of life after stroke – Full Text


Background and Purpose Depression following a stroke/poststroke depression (PSD) has been newly recognized as one of the most common complications after stroke. PSD may affect neuroplasticity and quality of life. The purpose of present study was to find out effects of depression on functional recovery, quality of life and neuroplasticity in patients with acute stroke. 

Methods: A total of 76 cases were recruited for the study and out of which 44 were available for the analysis after six months. Patients were divided into three groups according to severity of depression: Group A (without depression), Group B (mild-to-moderate depression), and Group C (severe depression) on the basis of Patient Health Questionnaire-9 (PHQ-9) scale scores. All patients were assessed for depression by PHQ-9, and for quality of life by Stroke Specific Quality of Life (SSQOL) scale. Neuroplasticity was assessed by measuring levels of serum brain-derived neurotrophic factor. 

Results: Quality of life was observed to be significantly affected by depression (P ≤ 0.05). The most commonly affected characteristics were energy, family roles, mobility, self-care, social roles, upper extremity function, and work productivity. Serum BDNF levels were also affected significantly by depression (P ≤ 0.05). 

Conclusion: PSD is a serious complication, affecting quality of life and neuroplasticity (BDNF) in patients. Decreased neuroplasticity further may affect functional improvement.


Despite decrease in stroke mortality rate, there has been increase in the stroke survivors with residual disability and impairment. This has grown interest in the factors that can affect recovery from stroke and quality of life.[1] Depression after stroke or poststroke depression (PSD) is one of the factors that can negatively influence the functional outcome after stroke but is often ignored. With a possible role also in cognitive status and survival, it is an obvious source of suffering for patients and caregivers.[2] PSD may impede rehabilitation, recovery, quality of life, and caregiver’s health.[3],[4],[5],[6] Depression after stroke, though recognized for more than a century, had never received the attention that has been devoted to other stroke complications, such as motor impairment, language problems, or cognitive deficits.[7] PSD not only leads to poor involvement in rehabilitation and delays functional recovery but results in limited social activity and increased disability.[8],[9] Moreover, 12.3–73.2% of stroke survivors suffer from concurrent depression and anxiety which further delays recovery from stroke.[10],[11],[12]

The prevalence of PSD (13.7–31.1%) is four times higher than the likelihood of having depression in the general population without comorbid physical disease. When physical recovery is the main focus of treatment, occurrence of depression and anxiety can be overlooked in the early stage of stroke recovery.[8],[13] Consequently, depression and anxiety are usually diagnosed poorly and inadequately treated.[8],[14] Recognizing these symptoms is difficult because they often overlap with stroke-related impairments.[11],[14]

Based on the literature, the most consistent factors associated with PSD are severe stroke and physical disability.[15] Close relationship between PSD and neurological deficits suggests that PSD may be a psychological, reactive depressive symptom associated with sudden functional deficits.[16],[17] When there are prolonged functional deficits, subsequent familial and social issues may perpetuate PSD.[18] Several clinical studies on major depressive disorder (MDD) have shown that blood–brain-derived neurotrophic factor (BDNF) is associated with depression response. BDNF is a neurotrophin related to neuronal survival, synaptic signaling, and synaptic consolidation.[19] Several studies have been performed assessing BDNF levels in MDD and showing important correlations between MDD and BDNF levels.[20]

Studies regarding the PSD and its impact on neuroplasticity and quality of life are still lacking. The current study was designed to assess patients for depression (by Patient Health Questionnaire-9 [PHQ-9]), levels of serum brain-derived neurotrophic factor (S. BDNF), and their impact on quality of life (by Stroke Specific Quality of Life Scale [SSQOL]) in patients with stroke.[…]

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[Review] Complementary therapies for clinical depression: an overview of systematic reviews – Full Text



As clinical practice guidelines vary widely in their search strategies and recommendations of complementary and alternative medicine (CAM) for depression, this overview aimed at systematically summarising the level 1 evidence on CAM for patients with a clinical diagnosis of depression.


PubMed, PsycInfo and Central were searched for meta-analyses of randomised controlled clinical trials (RCTs) until 30 June 2018. Outcomes included depression severity, response, remission, relapse and adverse events. The quality of evidence was assessed according to Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) considering the methodological quality of the RCTs and meta-analyses, inconsistency, indirectness, imprecision of the evidence and the potential risk of publication bias.


The literature search revealed 26 meta-analyses conducted between 2002 and 2018 on 1–49 RCTs in major, minor and seasonal depression. In patients with mild to moderate major depression, moderate quality evidence suggested the efficacy of St. John’s wort towards placebo and its comparative effectiveness towards standard antidepressants for the treatment for depression severity and response rates, while St. John’s wort caused significant less adverse events. In patients with recurrent major depression, moderate quality evidence showed that mindfulness-based cognitive therapy was superior to standard antidepressant drug treatment for the prevention of depression relapse. Other CAM evidence was considered as having low or very low quality.


The effects of all but two CAM treatments found in studies on clinical depressed patients based on low to very low quality of evidence. The evidence has to be downgraded mostly due to avoidable methodological flaws of both the original RCTs and meta-analyses not following the Consolidated Standards of Reporting Trials and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Further research is needed.

Strengths and limitations of this study

  • This systematic overview included the comprehensive literature search of important complementary and alternative medicine topics defined by the Cochrane Collaboration.
  • The inclusion criteria were restricted to meta-analyses of randomised controlled clinical trials (RCTs) of patients with a clinical diagnosis of depression.
  • The quality of evidence from meta-analyses was assessed according to Grades of Recommendation, Assessment, Development, and Evaluation.
  • There is a possible lack of evidence of newer RCTs, which have not been analysed by the included meta-analyses.


Depression is one of the most prevalent psychiatric disorders, with about 25% of women and 12% of men suffering from at least one depressive episode during their lifetime.1–3 According to the criteria for diagnosis recommended by the American Psychiatric Association (APA), depressive disorders can be distinguished by their degree of severity or duration and are also characterised by a high comorbidity and an increase of psychological strain for the affected person.4 It is evident that a strong comorbid connection to several chronic conditions like addictions,5 neurodegenerative diseases6 7 or different psychiatric diseases8–11 exists. This leads depressive disorders as one of the leading causes of disability worldwide.12

The most commonly used treatments for depression are antidepressants, psychotherapy or a combination of drugs and psychotherapy. While both treatment strategies (alone and in combination) have been shown to be effective,13–15 more recent meta-analyses also found high dropout and low remission rates16–21 as well as clinically significant differences between antidepressant drugs and placebos only for patients at the upper end of the very severely depressed category.22 This may lead patients to search for alternatives. Increasing mainstream use of complementary and alternative medicine (CAM) support this trend, particularly for different physical conditions with comorbid affective disorders.23–27 The NIH defines CAM as therapeutic approaches that are usually not included in conventional Western medicine systems.28 CAM therapies used in combination with conventional care are considered as complementary, those used instead of conventional care as alternative practices. Types of CAM approaches include natural products, such as herbs and dietary supplements (vitamins, minerals and probiotics) and mind and body practices, such as yoga, chiropractic and osteopathic manipulation, meditation, relaxation, acupuncture, tai chi, qi gong and hypnotherapy. Practices of traditional healers from Europe (naturopathy and homeopathy), Asia (Ayurveda and traditional Chinese medicine) and other continents are also classified as CAM.28 While some complementary therapies have become a promising adjunct in the standard treatment of depression,29 30 others are known for their possible side effects or interactions with standard drugs.30 Recent clinical practice guidelines, in addition, vary widely in their search strategies and resulting recommendations for CAM treatments. While the American College of Physicians (ACP),31 the American Psychiatric Association (APA)32 and the Canadian Network for Mood and Anxiety Treatments (CANMAT) guideline33 provide a more comprehensive overview and critical appraisal of CAM treatments, the Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN),34 the National Institute for Health and Care Excellence (NICE),35 and the World Federation of Societies of Biological Psychiatry (WFSBP)36 guidelines mainly focus on St. John’s Wort and light therapy. Possible effects and risks of further CAM therapies are not discussed. Thus, the purpose of this overview is to provide a comprehensive search strategy of relevant CAM terms and systematically summarise the existing level 1 evidence for clinical depression as a basis for further guideline recommendations on the efficacy, effectiveness and safety of CAM therapies.[…]

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[WEB PAGE] Individual frequency can be used to control brain activity – News

Reviewed by Emily Henderson, B.Sc.Aug 17 2020

Individual frequency can be used to specifically influence certain areas of the brain and thus the abilities processed in them – solely by electrical stimulation on the scalp, without any surgical intervention. Scientists at the Max Planck Institute for Human Cognitive and Brain Sciences have now demonstrated this for the first time.

Stroke, Parkinson’s disease and depression – these medical illnesses have one thing in common: they are caused by changes in brain functions. For a long time, research has therefore been conducted into ways of influencing individual brain functions without surgery in order to compensate for these conditions.

Scientists at the Max Planck Institute for Human Cognitive and Brain Sciences in Leipzig, Germany, have taken a decisive step. They have succeeded in precisely influencing the functioning of a single area of the brain. For a few minutes, they inhibited exactly the area that processes the sense of touch by specifically intervening in its rhythm. As a result, the area that was less networked with other brain regions, its so-called functional connectivity, decreased, and thus also the exchange of information with other brain networks.

This was possible because the researchers had previously determined each participant’s individual brain rhythm that occurs when perceiving touch. With the personal frequency, they were able to modulate the targeted areas of the brain one at a time in a very precise manner using what is known as transcranial alternating current stimulation. “This is an enormous advance,” explains Christopher Gundlach, first author of the underlying study. “In previous studies, connectivity fluctuated extensively when the current was distributed in different areas of the brain. The electrical current randomly sought its own path in the brain and thus affected different brain areas simultaneously in a rather imprecise manner.

In a preliminary study, the neuroscientists had already observed that this form of stimulation not only reduces the exchange of the targeted brain networks with other networks, it also affects the brain’s ability to process information, in this case the sense of touch. When the researchers inhibited the responsible somatosensory network, the perception threshold increased. The study participants only perceived stimuli when they were correspondingly strong. When, on the other hand, they stimulated the region, the threshold value dropped and the study participants already felt very gentle electrical stimuli.

The deliberate change in brain rhythm lasted only briefly. As soon as the stimulation is switched off, the effect disappears again. Nevertheless, the results are an important step towards a targeted therapy for diseases or disorders caused by disturbed brain functions”.

Bernhard Sehm, Study Leader

Targeted brain stimulation could help to improve, direct and, if necessary, attenuate the flow of information.

Source: Max Planck Institute for Human Cognitive and Brain Sciences

Journal reference: Gundlach, C., et al. (2020) Reduction of somatosensory functional connectivity by transcranial alternating current stimulation at endogenous mu-frequency.  NeuroImage.

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[Slideshow] Types of Depression

Antibiotics could be repurposed as a treatment for depression
tadamichi/ Shutterstock

Depression is more than just feeling down. It takes many forms. Learn more about those forms with this WebMD slideshow.


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This guide describes a sampling of these at-home biofeedback assistive technology (AT) devices that may help users better understand, interpret, and manage depressive effects that involve your brain, heart, and muscles. Biofeedback AT devices are designed to assist with monitoring and voluntarily controlling certain mental and physical functions such as increasing mental focus, regulating breathing, or relaxing muscles to get brainwaves, heartrate, and muscle tension levels back to normal intensities.

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