Sustaining a brain injury can be a very difficult thing for anyone to go through. Emotions such as anger, fear, sadness and worry are all common after a brain injury. It is normal to have these emotions. While these feelings may improve over time, some people may experience ongoing feelings of sadness and depression that interfere with their ability to enjoy life or complete their regular activities.
What is depression?
Feeling sad is a normal reaction to a distressing event such as a brain injury. It may take time to recover from the injury and to adapt to the change in your circumstances. If you find you are struggling with your emotions, regularly feeling low, or if these feelings have been going on for a long time, this may be a sign that you are depressed.
Depression occurs when feelings of sadness and hopelessness persist over time and these feelings impact on your ability to engage in regular daily activities.
Depression can often occur together with anxiety.
There are a number of common symptoms of depression. These include physical and emotional symptoms, as well as changes in your thoughts and how you behave.
Physical
Loss of appetite or over-eating
Poor sleep, sleeping too much or sleep being out of routine (e.g. sleeping during the day)
Feeling exhausted/no energy
Headache or other pain
Reduced sex drive
Emotional
Feeling sad, hopeless or miserable
Feeling worried, regret or guilt
Not being able to enjoy anything, even things which you know would typically make you feel happy
Low self-esteem
Thoughts
Thoughts that you are not worthwhile
Thoughts that everything is too much effort
Behaviour
Becoming withdrawn and isolated
Losing interest in your appearance
Losing interest in your work, hobbies or socialising
Finding it hard to get started with things, even normal activities
Finding it hard to concentrate and pay attention
Using alcohol, tobacco or drugs more than usual
Thoughts of harming yourself and suicide
For some people, depression may lead to thoughts about harming themselves or suicide. These thoughts can be distressing and difficult to manage.
It can be helpful to have a plan for what to do when these thoughts occur (e.g., call a friend/family member, have a planned activity you enjoy, contact agencies that can support you). Help is available and you do not have to manage these thoughts and feelings alone. Even if you do not think that you will act on your thoughts, it is still helpful to speak with your GP or another medical professional about how you are feeling, so that support can be provided.
You can also text SHOUT to 85258, call the Samaritans or contact your local NHS urgent mental health helpline for help. The Stay Alive app provides a resource with lots of useful information on how to stay safe in a crisis.
Our nurse-led helpline is also available to offer emotional support and advice on any aspect of life after brain injury, including feelings of depression.
If you feel the need to self-harm or have already harmed yourself and need immediate assistance, call 999 or visit your local A&E department.
Identifying depression after brain injury
Along with considering the symptoms of depression outlined earlier in this publication, the NHS’ ‘mood self-assessment’ questionnaire can help you to identify whether you have symptoms of depression and anxiety.
Some people experience physical disability or changes in their cognitive (thinking) skills after brain injury. The impact of these physical and cognitive changes can also influence feelings of depression after a brain injury.
Friends and family may also be able to identify signs of depression that you may not recognise for yourself (e.g., if your behaviour has changed). You can discuss your feelings with your GP who can direct you to the appropriate support and treatment to meet your emotional needs. This may include a self-management plan, referral to professional services and/or medication.
Tim's story
“The word ‘mental’ has connotations that the older generation, in particular, sees as a negative, whereas more people suffer from this type of ‘debilitation’ than most people know.
“Poor mental health is nothing to be embarrassed about and should not carry a stigma. People don’t choose to have mental health issues; it’s not their fault.”
Find out more about Tim's story.
Tips for managing depression after brain injury
The tips in this section are suggestions for coping with depression after brain injury. Some tips may be more helpful to you than others and you may need to try several things to find what works for you personally.
Talk to your family and friends about how you are feeling
Letting your family and friends know how you are feeling can help you to feel less alone with your emotions and thoughts. It may also help your family and friends to understand why your mood or behaviour may be different after your brain injury. You may also be able to let others know how they can best support you. If you find it difficult to speak to others or are struggling to express yourself, try to find other ways of communicating such as sending a text message or a voice note.
If you are working or involved with social groups, it may also be helpful to make your employer/ group members aware that you are feeling depressed and consider how the people around you can best support you.
Try to stay socially connected
Depression can sometimes make it difficult to socialise with others as you want to be alone. It may be helpful to connect with others. If you are unable to attend large gatherings, ask a close friend to meet with you at a quiet location such as your house or a local park.
You can also connect with other people through text messages, calls, social media, or online communities such as Headway’s HealthUnlocked community, which may feel more manageable than physically seeing people.
You may wish to consider finding a local support or activity group where you can meet new people and try out new activities, such as your local Headway.
Do activities that you enjoy
Do what matters to you. Listening to music that you love, creating some art, reading a book, going outside (e.g., for a walk or to sit in the park), seeing a special person in your life, can help. Depression can make it difficult to engage in activities but try to spend some time each day doing something you enjoy or trying something new. Setting yourself small realistic actions to achieve in the next hour/ hours/ days can help. Start small and you can build up slowly to achieve the things that are important to you.
Learn about brain injury
Knowing about your brain injury and how it affects you can help you to understand why things are difficult and may help to explain why you are feeling depressed and down. Knowing more about your particular injury can also help you to find ways to manage some of the changes you are experiencing. Having a greater sense of knowledge and control over your injury can lead to improvements in your mental health.
Try to exercise for a few minutes every day
Exercise is a proven method for improving low mood and may be an effective way for you to manage depression. If you have limited mobility, speak to a professional such as a physiotherapist or your GP about exercises that are suitable. Try to set yourself a routine so that you stay motivated to exercise every day, even if it is just for a few minutes.
Identify issues in your life causing or contributing to depression
Try to identify any issues that may be causing or contributing to your depression (e.g., worries about work, financial difficulties, family burden) and try to seek help for these from relevant professionals. You can contact Headway for guidance on where best to access support.
Consider putting together a ‘soothe box’
A ‘soothe box’ is a physical box that contains personal items that can provide comfort when you feel upset. This box could include things like photos of people you care about or places you have visited, things you can touch and do things with (e.g., a colouring book, smelling perfumes, touching soft fabrics) or prompt cards with guidance on it (e.g., go for a walk, call a friend) or motivational statements. You can personalise this box to include the things which will personally comfort you.
Consider using wellbeing techniques
While there is limited research to show whether techniques like mindfulness, yoga and meditation are effective for managing depression after brain injury, some people find these techniques helpful. Speak to a suitably qualified therapist if you are considering trying any of these techniques out, as they may be able to guide you through learning how to effectively practice them. There are a number of apps which can support you with practising mindfulness, meditation and compassionate approaches.
Maintain a healthy lifestyle
Maintaining a healthy diet, drinking plenty of water, avoiding alcohol and illicit drugs, and trying to ensure that you have a good night’s sleep can help with managing depression. For more information on maintaining a healthy lifestyle, visit NHS Choice’s ‘Live Well’ website.
Using technology
There are a range of apps which provide support for managing depression. Always check details and reviews of an app before you download it and be aware of any privacy settings and costs involved.
Seek support from other services
Headway services such as the helpline or your local Headway can offer emotional support if you are feeling depressed. There are also organisations that specifically offer support to people with their mental health, although these may not be experienced in supporting people with brain injury
Professional support
There are a number of different professionals that can support someone who is depressed. However, it is best to get support from a professional that has experience of working with people with brain injury. This would be either a clinical neuropsychologist or a clinical or counselling psychologist who specialises in brain injury. You can get a referral to these professionals either through your GP or privately. Counsellors may also be able to offer support through talking therapies and provide a space for you to talk about your feelings. The British Association for Counselling and Psychotherapy has a therapist directory that you can use to search for private counsellors.
If you live in England, you can ask your GP to refer you or you can self-refer to a local psychological therapies service, called Improving Access to Psychological Therapies (IAPT). Your GP can help you with finding details of services available in your area, or you can find your local services using the NHS website. Within Northern Ireland, Scotland and Wales, you can ask your GP to refer you for mental health support.
Medication
Some people benefit from taking medication to help with managing depression, either alongside or instead of talking therapies. Your GP should be your first point of contact with whom to discuss trying or modifying your medication. It is very important that you never stop taking or change the dosage of your medication without guidance from a suitably qualified medical professional. If you are having problems with your medication, speak to your GP as soon as possible to request a review.
The organisations listed on this page are provided for information purposes only. Their inclusion does not imply endorsement, recommendation, or approval by Headway. Users should make their own assessment of any organisation or service before engaging with them.
The information on this page was produced with expert support from brain injury survivors and Dr Cliodhna Carroll, Clinical Neuropsychologist at St George’s Hospital and Allied Neuro Therapy Ltd., and Dr Elizabeth Samuel, Clinical Psychologist at Kent and Medway NHS and Social Care Partnership Trust, Clinical Neuropsychology Service.
This information was last reviewed in 2022.
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