I am a 29-year-old woman who recently suffered a mild stroke. Is it normal to go through severe depression after a mild stroke?
Wait until you turn 30 and tell us how depressed you are.
On to your real question. After a traumatic event such as a stroke, it is not surprising that you feel depressed. A stroke can result in major life changes. You may not feel like your old self. Perhaps your abilities are impaired now. Or, maybe you are just having a hard time getting back in to the routine of life after such an unexpected upset.
You need to consider two possibilities. First, you may have sustained organic injury to your brain which is causing this mood alteration. Neurological and neuropsychological tests can reveal that. For example, someone with frontal lobe damage may be expected to act different than he used to prior to the brain injury, since the frontal lobe controls much of our personality/behavior.
Second, you may be reacting normally to a traumatic event. In this case you could be told by a psychologist or psychiatrist that you are experiencing a major depressive episode. If you have 5 or more of the following characteristics most of the day, nearly every day, for a continuous 2- week period, you could be diagnosed as clinically depressed: (1) Depressed mood; (2) Diminished interest in almost all activities; (3) Significant weight loss or gain; (4) Cannot sleep or need much more sleep than usual; (5) Psychomotor agitation or retardation; (6) Fatigue or lack of energy; (7) Feelings of worthlessness or excessive guilt; (8) Diminished ability to concentrate; (9) Recurrent thoughts of death, or suicidal ideation, plan or attempt.
In any case, Pat would feel better and probably you will too if you see a psychiatrist for an evaluation and possibly medication; there are many medicines that can alleviate depression. At the same time, you should see a counselor. This piece is critical to your examining your life and feeling good about it again. This combination of psychiatry and counseling should help (and then maybe 30 won't be so devastating either).
I am looking for any information on help for a person with traumatic brain injury who has aggressive, violent episodes. The individual is now 39, was 6 when accident occurred. He is falling through the system, difficult placement due to behaviors. But behaviors are not all the time. There is a great person trapped. Would like to be able to offer parents hope. Also are there any support groups for the parents of traumatic brain injury?
If you read the question right before yours, you know that you are not alone in experiencing problems finding an appropriate placement for persons whose neurological problems lead to aggressive or violent behavior. Unfortunately for this gentleman, he’s very young and appropriate placements may be even harder to find. There are many persons with brain injury in the criminal justice system because of their inability to control their impulses. If he is a danger to others, it is extremely important that he follow the treatment recommendations of his doctors very closely. A few suggestions –
- Be sure he is properly medicated and closely followed by a psychiatrist who has expertise in working with persons with brain injury and/or managing violent behavior.
- Talk to a psychologist or other behavior management expert about what the family can do to set up a good environment for this man. Encourage him to participate in psychotherapy with a neuropsychologist or other therapist specializing in brain injury rehabilitation. Support groups are also helpful for many persons with brain injury – it’s often easier to talk to others who have "been through it."
- Try to identify what triggers the "violent episodes." Is he having seizures that contribute? Do "episodes" occur when he is overwhelmed, stressed, or fatigued? Does alcohol and/or drug use contribute? Identifying situations likely to bring on aggressive behavior can help to avoid the situation in the first place.
- Consider if there are emotional or psychological factors that contribute. Frustration, depression, or anxiety can contribute to angry and aggressive feelings.
Although persons with brain injury often have more difficulty controlling violent or aggressive impulses, this doesn’t mean it’s impossible. It also does not excuse violence or hurting others. If the person knows right from wrong and is cognizant of the problem, it is his responsibility to follow treatment guidelines, accept responsibility for his actions, and work to modify his own behavior or avoid situations likely to cause "outbursts."
Finally, yes there are support groups for family members of persons with traumatic brain injury. Many patient groups also welcome family members. Contact your state’s Brain Injury Association chapter or visit http://www.biausa.org for more information – including contact information for the state chapters.
Ten years ago my husband had a brain aneurysm followed by two strokes. The doctors told me his whole brain was full of blood. In the last few years, he has had spells of memory loss, confusion, and agitation. He cannot do everyday normal work. In the last year, he has gotten much worse. He has become very violent and has told me he will kill me when I’m asleep. He is paranoid. When he was in the hospital, they said he was fine and his EEGs were normal. His answers to most of the things they asked him were wrong. He tells them about events that have not happened. I am not safe in my own house. I don’t know what to do anymore.
If you believe that your husband is a serious threat, you need to make sure you are safe. As tragic as his injury is, if he is paranoid and threatening you, you need to protect yourself – even if you know the behavior isn’t your husband’s fault. If your husband is currently a danger to you, you really need to leave the home and stay somewhere else until you believe his behavior is under control. As sad and tragic as your husband’s illness is, think how tragic things could be if he hurts someone else.
I’m not sure what’s happening when you say the doctors "said he was fine." Are you talking about when he was hospitalized for the strokes? Or are you talking about more recently? Clearly, he should receive a comprehensive psychological and/or neuropsychological evaluation. You need to make mental health professionals aware of his symptoms so he can get proper treatment. There are some medications that can help control psychotic symptoms (such as paranoia and delusion). If he is making threats or exhibits other dangerous behavior, you may be able to ask the police or a judge to hospitalize him until his behavior is under control.
Since my brain injury 2 years ago, I have had many problems that will not go away. I feel depressed and angry most of the time. I get very impatient with people. It’s difficult for me to concentrate and I’m often forgetful. I couldn’t keep up at work and I lost my job 6 months ago. Since then, I haven’t felt like being around people much at all. The only people I have to talk to are my children. Even they don’t understand what I’m going through. They keep telling me to “get over it” and find another job. So far, I haven’t been able to do either one of those things. I feel too sad and irritable to even think about working. I finally broke down and told my doctor about how I’ve been feeling lately. She started me on Prozac last month. I feel a little better, but I’m still having a pretty hard time. What else can I do to start feeling better? Are there people out there who will believe that my problems are not imaginary?
--“All in my head” in Hanover
You may be surprised to find out your symptoms are not so unusual. Problems like the ones you describe are quite common after a brain injury in fact. Many people recovering from brain trauma notice changes in their emotions and thinking. You’ve taken good first steps to reach out and find others who do understand what it’s like to survive a brain injury.
From the letter you wrote, your doctor seems to believe that your problems are real and that they deserve treatment. Depression after a brain injury is an all too common difficulty. Reactions to loss and life changes, or changes in brain chemistry, or both may account for post-injury depression. There are many medications for depression and other emotional problems that may be helpful for you. Keep your doctor informed about how the medication is (or is not) helping. Be willing to try different medications if necessary.
If you find that medications aren’t helping enough, you may want to think about other kinds of treatment or support. Many people find individual and group therapy, for example, helps during the short and long-term phases of recovery. Your doctor may know a rehabilitation specialist in your area who provides counseling for people after a brain injury. Joining a group for survivors of brain injury is another great idea. You are likely to find the support, guidance, and advice of other people with similar experiences very helpful.
There is a community of survivors, family members and friends, and treatment professionals that will not dismiss your concerns. The Brain Injury Association of Virginia (804-335-5748 or toll free 1-800-334-8443) is a wonderful organization to contact. They are an excellent source of information about treatment specialists, programs, services, and support groups in your area.
Our 26-year-old daughter was badly hurt in a motorcycle accident 3 years ago. She broke a leg and both arms, had bruises from head to toe, and had a massive brain hemorrhage. There was a time when we didn’t think she would make it. Luckily, she had great surgeons that literally saved her life. We were filled with hope during her quick physical recovery. What has been most difficult has been watching her mental struggle with the effects of a brain injury. Even after all this time, she still forgets everyday things, has trouble keeping up with conversations, and gets tired so fast.
Since she was discharged from the hospital and finished treatment, my husband and I have been taking care of her at home. We love our daughter very much and would do anything to help her get better. I have noticed, though, that her temper is much shorter since the accident. She argues with my husband about everything. In her defense, my husband likes to tell her what to do and how to do things. I think he has a hard time letting her make her own decisions and mistakes. I know my daughter is growing more angry and resentful about the way she is being treated. What can I do, Pat, to keep the peace at home between my daughter and husband?
Wanting the members of your family to be happy and to get along is a natural response. I bet your motherly instincts about conflicts between your daughter and husband are right on target. The trick, however, is to avoid being the target! In other words, when family members argue, some unlucky person may find herself caught in the middle. During stressful times, you may also feel extra pressure to help everyone in the family get along.
Realizing that your family has been through a series of stressful events since your daughter was injured is important. First, you and your husband were faced with the possibility that she may not survive the accident. Second, you were concerned about her mental recovery once her physical health was restored. Lastly, you have seen signs of lingering cognitive and emotional problems that are worrisome.
You and your husband may also be under stress because of the responsibilities of taking care of your daughter. Assuming she was living on her own before the accident, you and your husband had probably just gotten used to having an “empty nest” when she moved back home. Having an adult child in the home after a period of absence would be a significant change for any couple. Also, the strain of caregiving should not be overlooked. Relatives providing care to persons with brain injury may find the responsibility rewarding but burdensome. Adjusting to these life-altering changes is understandably difficult for your family.
Following a brain injury, survivors are more vulnerable to stress of daily hassles as well as major life changes. That’s one reason why people with brain injury often have trouble controlling frustration and anger. There are a number of constructive ways to cope with anger problems that survivors and their families have shared with me over the years. To help your daughter increase her self-control, try the following ideas other survivors and their families have found helpful:
- Encourage her to be positive and sensitive to others' feelings. Remind her to explain herself calmly. Doing so will make it easier for others to understand and help.
- Help your daughter remember that controlling her anger will improve relationships with family and friends
- Encourage your daughter and husband to take a "time out" and try to relax when angry feelings start to build. Helpful strategies include breathing deeply and slowly or counting to ten before speaking or acting.
- Identity trouble situations, people, and places that bring out your daughter's anger. Make a plan to deal with trouble situations and practice the plan ahead of time.
- Be a good role model and encourage your husband to do the same. Teach good anger management skills by using them yourself.
Patients and families may need additional help during especially stressful times. Talking to extended family members, friends, or professionals can benefit families with complex and challenging issues as the ones you have described. For example, you may consider asking others for help in caregiving. A short break or chance for respite often makes it easier for family caregivers to cope over the long term. You may also wish to contact the Brain Injury Association of America (BIAA). BIAA offers a telephone helpline for families (1-800-444-6443) as a nationwide source of information and referral services. For emotional support, participating in a local support group for persons with brain injury and their families is another possibility. The Brain Injury Association of Virginia (BIAV; 804-355-5748 or 1-800-334-8443) provides information about support groups and other useful services for survivors of brain injury and families.
If you are seeking individualized help, you may wish to consider counseling for yourself or your family. BIAV has a list of mental health professionals with brain injury experience throughout Virginia offering individual and family counseling. Another source of treatment may be found in the Department of Physical Medicine and Rehabilitation at Virginia Commonwealth University (VCU). The family support program at VCU provides education, counseling, and referral services addressing the unique needs of persons with brain injury and their families. Laura Taylor may be contacted to learn more about this program and to see if you are interested in participating (phone: 804-828-3703/1-866-286-6904 or email: firstname.lastname@example.org).
I have a friend who had a serious brain injury last year. She fell off the horse she was riding and was knocked completely out. I'm glad I was riding with her that day so I could go find help. We got her to the hospital right away. They said she was in a coma from her injury. She spent several weeks at the hospital and slowly got better. When she went home, we threw a big party for her, but it didn't seem to cheer her up much. It's been months since the injury, and she still seems sad all the time. Whenever I ask her to do things with me, she puts me off mostly. I have to insist before she'll even go out to see a movie or eat lunch with me. This isn't like her at all to be so isolated and down.
What can I do to help my friend when she won't even talk to me about what's wrong?
After brain injury, people often have a hard time dealing with life changes that may follow like seeing different doctors, going to physical therapy appointments, being unable to drive, or missing work. Changes in brain functioning after an injury may also play a role in emotional difficulties. The physical wounds of a brain injury often heal much more quickly than the emotional ones. You are a good friend to notice that she needs help feeling better. Despite your best efforts to cheer her up, sometimes it takes help from professionals to start feeling positive again after brain injury.
The Brain Injury Association of Virginia (BIAV), located in Richmond, has information about services for persons with brain injury. The friendly staff at BIAV would be happy to share their resources for persons after brain injury. For example, BIAV has a list of local brain injury service providers (doctors, psychologists, and counselors), information about support group meetings, educational materials about brain injury, and other resources in the community. You and your friend may consider attending a support group to learn about coping with brain injury first hand from people with brain injury and their family members or friends. Perhaps, you can invite your friend for an early supper then go to a support group together!
To learn more about support groups in Virginia for survivors of brain injury and their family members or friends, contact BIAV by phone (804-355-5748 or toll free 800-334-8443), e-mail (email@example.com), or send a letter to the address listed below:
Brain Injury Association of Virginia
3212 Cutshaw Avenue, Suite 315
Richmond, VA 23230
Toll free: (800) 334-8443
For people with brain injuries having a difficult time adjusting, there are a number of studies going on at Virginia Commonwealth University (VCU) Medical Center in Richmond which may be helpful. There are two studies which may be of interest to your friend. One study helps identify symptoms of depression after brain injury. The other study provides treatment to persons with severe depression following brain injury. To learn more about options for people with brain injury to volunteer in a study (or two), read on!
In one study, researchers are trying to figure out the best way to identify emotional changes after brain injury. People volunteering for the study will talk with someone about emotional changes they've noticed since their injury. A short test of mental functioning will also be given. They will be interviewed on two occasions -- once as soon as a visit can be scheduled, then again three months later. If a serious emotional problem is found or the person is interested in treatment, options that may help him or her feel better will be discussed. People without clear signs of emotional difficulties after brain injury can also volunteer for the study if they like.
Another study at VCU Medical Center hopes to find out whether medication for depression helps people with brain injury feel better. The survivor will be seen by a doctor and research staff every one or two weeks for three months while on medication to check the person's response. Volunteers are not charged any fees to take part in these studies. To learn more about these research projects, you, a family member, or another friend may call Jenny Marwitz (804-828-3704 or toll free at 866-296-6904). Your local chapter of the Brain Injury Association of America (toll free at 800-444-6443 or internet www.biausa.org) may provide information about ongoing studies or support services for persons with brain injury in your area. Contact information for other national organizations with information about brain injury research and recovery are provided below:
National Institute on Disability and Rehabilitation Research (NIDRR)
400 Maryland Avenue, S.W.
Washington, DC 20202-7100
TTY: (202) 245-7316
National Institute of Neurological Disorders and Stroke (NINDS)
NIH Neurological Institute
P.O. Box 5801
Bethesda, MD 20824
(800) 352-9424 or (301) 496-5751
TTY: (301) 468-5981