Question: Does depression give more of an impact for people with brain injuries? if so, how?

Andrea Kusec answered on 19 Mar 2020:

Great question! People with brain injury are more likely to have depression for multiple reasons.
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One, people with an injured brain often have a decreased ability to experience pleasure. At the neural level, the chemical responsible for reward (dopamine) is released at a slower rate and/or releases less in response to something positive happening (for example, when you do well on a test). By experiencing fewer feelings of reward, the brain basically interprets this as “nothing really makes me happy” and can kickstart depression.
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Two, people with brain injury often have limited physical capability (either due to the brain area that controls physical function being damaged, or they have physical injuries on top of their brain injury, such as after a car accident). For example, they might not be able to walk ever again, they might not be able to use their arm, and this leads to them not being able to do things they normally would – they might lose their license, they might not be able to move around without help from someone, or they give up on trying to do what they normally do because with these new difficulties things take longer and are more effortful. This can make depression more likely because people often feel very upset at this sudden loss of ability to do their day-to-day activities, even simple things like being able to brush their teeth on their own.
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Three, people with brain injury often have poor cognitive abilities, such as memory and attention. They might not be able to remember all of the good things that have happened in their life, or when good things happen to them, they have a hard time paying attention to what is happening in the moment, which affects their ability to keep positive experiences (such as a funny joke told with friends) in their long term memory. A lack of positive memories makes someone more likely to be depressed.
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Four, people with brain injury are more likely to lose their jobs, their friends, and have increased difficulties with family members as a result of the sudden increase in the need for care and support, or because they weren’t able to get appropriate support after their injury due to cost. This can lead to people with brain injury feeling socially isolated, disconnected from others, and thus lead to depression. When you combine these social factors with the three factors above, depression is very likely to occur (In fact, 1 in 3 people with brain injury will be depressed – compared to 1 in 6 people without brain injury will be depressed).
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I hope this answers your question! Very happy to provide any further detail.