Beyond the Physical: Concussions and Mood

By: Maura L. Johnson

On a cold January evening in 1997, five friends and I packed ourselves into my friend’s Geo Metro, a vehicle most certainly not made to accommodate a group of that size. Most of us were still just 15, but our friend had the lucky October birthday and the brand new driver’s license to go with it. As we drove around aimlessly (a favorite pastime of small-town teens everywhere), we felt a sudden, sharp jerking motion, followed by fishtailing and a crash into a telephone pole.  While only one of us came out completely unscathed, we were incredibly fortunate that no one was injured beyond recovery. Three of us, including myself, were diagnosed with concussions of varying severity. I was told to be mindful of several potential concussion-related ailments, such as headaches, dizziness, and muscle pain and whiplash. While I experienced each of these in spades, my family and I were wholly unprepared for the agitation and depression that followed.

What I later learned is that mood changes after concussion are far more common than many people realize. Concussions can affect mood both in the days immediately after the injury and, for some people, for weeks or months afterward. Symptoms can occur even when brain imaging may appear “normal” and may also vary from person to person. Some mood-related symptoms to watch for following a concussion may include:

• Irritability or feeling short-tempered

• Anxiety or excessive worry

• Sadness or depression

• Emotional sensitivity, such as tearfulness in response to events that would not typically cause upset

• Mood swings

• Apathy, feeling “flat,” or reduced motivation

  
  

These symptoms can arise for several reasons:

• The brain is recovering from the injury, which can temporarily affect networks involved in emotion regulation.

• Physical symptoms such as headaches, dizziness, poor sleep, and fatigue can worsen mood.

• The stress and sadness of missing typical activities, inability to exercise and limits on physical activity, missing out on experiences with friends and family can negatively affect mood.

• Having a history of anxiety and/or depression may make symptoms more noticeable

Working with children and teens, it’s not uncommon for me to see several post-concussion clients each year. Sports-related accidents appear to be the most common, particularly among those who have suffered multiple concussions. One of the first things I focus on is screening for depressive symptoms, including increased irritability, agitation, and emotional flatness. Lack of motivation or lack of interest in previously enjoyed activities, as well as sadness related to limits on movement and activity participation and difficulty focusing may also be present. If possible, I will also provide psychoeducation to parents regarding the possibility of post-concussion mood disturbance, encouraging support, understanding, and, most of all, patience.

It’s important to realize that mood-related symptoms are common after a concussion and may be a completely new experience for affected individuals. Keeping providers informed, engaging support, and seeking therapy can all be incredibly helpful in aiding one’s recovery.  Prioritizing sleep, social connections, maintaining routines, and being as physically active as permitted are also ways to support recovery, as well as improve mood in general.