It is not uncommon for people with TBI to become depressed. This depression comes from both the physical changes in the brain due to the injury and the emotional reactions to it.

It is sometimes difficult to tell the difference between symptoms of depression and effects of the TBI. For example, depressed people and people with TBI may have:

  • Low activity level
  • Sleep problems
  • Difficulty controlling emotions
  • Lack of initiation
  • Feeling “down” with a depressed mood
  • Changes in libido (sexual desire)

Men and women often have different symptoms of depression. They also have different ways of coping with the symptoms.

Men often report symptoms of:

  • Fatigue
  • Irritability or anger
  • Loss of interest in pleasurable activities
  • Sleep disturbances

Men are more likely than women to use alcohol or drugs when they are depressed. They may engage in reckless, risky behavior. Men also tend to avoid talking about their feelings of depression with family or friends.

Women are more likely to talk about depressive symptoms to others. They often report feelings of:

  • Persistent sadness
  • Anxiety
  • Excessive crying
  • Feelings of guilt or worthlessness
  • Decreased energy
  • Increased appetite
  • Sleep problems

Women are more likely than men to experience weight gain associated with depression.

Depression can be treated with counseling and medication. Additionally, depression may affect the whole family, in which case marriage and/or family therapy can help.

In severe cases, both men and women may experience thoughts of self-harm or suicide.

If you suspect that the service member or veteran is depressed, ask your healthcare team to evaluate their mental health. This is very important.

What might you see?

  • Persistent sadness, anxiousness, or "empty" feelings
  • Feelings of hopelessness and/or pessimism
  • Feelings of guilt, worthlessness, and/or helplessness
  • Irritability, anger, or restlessness
  • Loss of interest in activities or hobbies once pleasurable, including sex
  • Fatigue and decreased energy
  • Problems concentrating, remembering details, and making decisions
  • Insomnia, early morning wakefulness, or excessive sleeping
  • Overeating or appetite loss
  • Persistent aches or pains, headaches, body aches and cramps, or digestive problems that do not ease, even with treatment
  • Less attention paid to grooming and personal appearance
  • Thoughts of self-harm, suicide, or suicide attempts

How can you help?

  • Offer emotional support, understanding, patience, and encouragement. Encourage participation in treatment, such as behavioral health counseling.
  • Remind your family member that depression usually gets better with time and treatment.
  • Talk to the service member or veteran and listen to them carefully.
  • Acknowledge their feelings, point out realities, and offer hope.
  • Encourage involvement in activities outside the house (for example, walks, shopping, movies, religious services, or volunteering). If they decline, keep making gentle suggestions, but don’t insist.

Remember, depression is common as a person struggles to adjust to the temporary or lasting effects of TBI. Being depressed is not a sign of weakness. It is not anyone’s fault. Help is available. Do not wait to call someone if you think the service member or veteran needs help.

Know the signs of a person thinking of suicide:

  • Making a will
  • Taking steps to get affairs in order
  • Giving away personal possessions
  • Sudden requests to visit friends or other service members or veterans
  • Purchasing a gun or stockpiling medications
  • A sudden and significant decline or improvement in mood
  • Writing a suicide note

If you notice any of the above signs, call 911 immediately or bring your family member to the closest hospital. It is appropriate to directly ask the person if they have been having suicidal thoughts. If yes, ask them if they have a specific plan in mind. Having a plan for killing oneself is a serious sign and requires immediate help.

Always take a person’s threats of suicide seriously. Get immediate help. Call the healthcare team or an emergency hotline (DoD/VA: 1-800-273-TALK) right away. Make sure to remove or secure any available firearms or other potential weapons.