This is a part of the Hot Topic podcast series from the Model Systems Knowledge Translation Center on TBI and Depression. Brandon Blake and Michelle Kauffman share how they worked with TBI Model System researchers to address challenges they faced with depression after experiencing a TBI.
Brandon Blake: You know, my brain is an interesting thing these days. I feel like when I have my, my moments of depression, anxiety, sadness, I have to fight such dark, negative stuff. And I’m so affected by human emotion that the slightest, the slightest injustice to somebody just breaks me up, and seeing somebody unloved or — it just kills me. And it’s the part of my brain injury that people can’t see.
It’s been almost a year since Brandon Blake sustained a traumatic brain injury. A car made a quick left turn in front of him at a yellow light while he was on his bicycle commuting home in Seattle. At the corner of Dexter and Harrison, Brandon’s face smashed into the beam above the car’s passenger-side window.
Brandon Blake: My jaws were wired shut. My teeth were destroyed. My jaw was broken. And I was happy to be alive, but I was like, what is going on.
Like a lot of people with traumatic brain injury, or TBI, Brandon struggled with his memory, insomnia, fatigue, his balance, and debilitating headaches. On top of all that, Brandon was hit with a deep and dark depression.
Brandon Blake: Just spiraling out with these negative feelings and thoughts and being kept up at night by them and having wild insomnia.
Before the bike crash, Brandon and his wife, Sabrina, lived a very active, happy life.
Sabrina: Brandon before his TBI, he was very outgoing, very gregarious, very social. He worked with children. He was a preschool teacher, and he had a very fun-loving personality and was very — just very friendly.
But Brandon’s brain injury upended all of that. Major depression affects nearly half of all people who sustain a brain injury as severe as Brandon’s. Dr. Jesse Fann of the University of Washington explains:
Dr. Jesse Fann: Direct injury to the brain can impact areas, can affect areas of the brain that control emotions. And injuries to those areas can cause imbalances in the natural chemicals in a person’s brain.
The circumstances surrounding a tragic event like a traumatic brain injury can also lead to depression. Brandon lost his beloved job teaching preschool, he lost some of his friends, he lost the things he loved to do … bicycling, skiing, playing music, and making art. He felt like he’d lost himself.
Brandon Blake: Brain injury’s huge. It’s like it’s … in a lot of ways, it’s like the most debilitating injury ever. When you break your leg, people can relate to that. Aw, you broke your leg. You poor thing. But when your brain gets injured, it’s a different kind of injury. It’s an injury that nobody can see. It’s an injury to your psyche.
Dr. Chuck Bombardier: Hey, Jesse. How’re you doing?
Dr. Jesse Fann: Hey, Chuck. Good. Good.
Dr. Chuck Bombardier works with Dr. Fann at the University of Washington’s TBI Model System, funded by the National Institute on Disability and Rehabilitation Research. They conduct research and provide evidence-based care for people with depression after TBI.
Dr. Chuck Bombardier: We can see people who have brain injuries. Their lives have been disrupted and so forth, and our response to them can be like, I’d be depressed, too. And so we can kinda think, like, it’s normal to be depressed, and that could lead to lack of treatment for depression. And so what we really want to emphasize is that it’s not normal to be depressed. It’s a problem if a person’s depressed after brain injury, and it merits treatment.
Depression is not only feeling down, sad, or blue. Depression can lead to low energy levels, poor concentration, changes in sleep patterns, and changes in appetite.
Brandon Blake: I stayed up, on average, until two, three o’clock in the morning. I would forget to eat, or I would eat too much.
Depression can also lead to loss of interest in usual activities, hopelessness, and social isolation. In severe cases, people can have thoughts of suicide. Not surprisingly, depression can cause all the other therapies that patients with brain injury may need — physical therapy, occupational therapy, speech therapy — to be less effective.
Dr. Chuck Bombardier: In a process of, like, trying to go back to work or school, maybe the person feels hopeless. They don’t really engage with the — with the vocational rehabilitation counselor. If we treat the depression, maybe they’re going to be more hopeful and invigorated and, you know, positive about returning to work.
Brandon’s treatment for his depression began one month after his crash, when he made his first visit to a mental health therapist.
Dr. Samantha Artherholt: Brandon?
Brandon Blake: Hey, Samantha.
Dr. Samantha Artherholt: Hi, there. Come on back.
Brandon Blake: Thanks.
Brandon’s therapist is Dr. Samantha Artherholt.
Dr. Samantha Artherholt: I think with Brandon what I’ve seen is that he’s — overall I think his mood has improved pretty significantly. That’s not to say that he doesn’t have his down days or that he doesn’t have days where he’s more anxious or more depressed than others. In the context of TBI specifically, we do see that. We see the emotional volatility. We see some ups and downs.
Dr. Samantha Artherholt: So how have things been?
Brandon Blake: Good. I’m really excited about the concert coming up.
Dr. Artherholt helps Brandon manage his depression using cognitive-behavioral therapy.
Dr. Chuck Bombardier: When people are depressed, they usually are physically inactive. They usually have very negative beliefs. They usually stop doing things that are rewarding. And so our — the idea behind cognitive behavior therapy is to help them resume all those things — help them become more physically active, help them resume things that are rewarding and help them recognize through their thinking the positive things that they are doing.
But for someone recovering from a traumatic brain injury and struggling with depression, finding something enjoyable to do can feel like a monumental challenge.
Dr. Chuck Bombardier: It’s really hard. It’s hard to help people get more active, because they are — sometimes have pain or disabilities. So it is difficult. So it really takes some hard work, some commitment, and meeting with a therapist.
People can see improvement in their mood in as little as four to eight sessions. But each person needs to partner with their therapist to find the treatment plan that is best for them. Brandon has been seeing a therapist every week since about a month after his crash.
Dr. Samantha Artherholt: So how’s that been in terms of planning and organization? That’s been a lot of work for you to plan that concert.
Brandon Blake: Yeah. It has been a lot of work. It’s been good. You know, I feel overwhelmed at times.
Therapy has given Brandon the skills he’s needed to get back to enjoyable and meaningful life activities, which are critical to treating his depression and anxiety.
Dr. Samantha Artherholt: I think of it as a three-legged stool of there’s the social activity, the recreational activity, and the physical activity. And you really do need to have elements of all of those to maximize your mood.
Music was one of Brandon’s recreational activities that he was able to return to most quickly, a few months after the crash.
Brandon Blake: And I remember the first time I picked up my bass after my accident. When I got past that feeling of, oh, my God, can I play, and I realized that my fingers were — still had that, it was a connection that became a therapy. And music became a therapy that was so deeply personal. And then when I get together with my bandmates, then it becomes a social experience. And then I’m so free and non-isolated, and the music blooms. It just all comes out, all my energies, all my emotions, and we just lay it all on there.
That social experience was important for Brandon’s recovery.
Brandon Blake: It’s easier to isolate myself with my brain injury, because it’s comfortable and it’s quiet. But without those people, my brain starts to spiral out into needing and yearning for that connection with other people.
Sabrina found a TBI support group for Brandon through the Brain Injury Alliance of Washington.
Brandon Blake: the moment I set foot in a traumatic brain injury support group, it changed my life, because I went from having nobody that knew what I was going through to having this awesome community of people who can totally understand.
Brandon met Michele Kauffman at his support group. Michele struggled with untreated depression and alcohol abuse for years, and then she sustained a brain injury.
Michele Kauffman: I was doing my laundry and I fell down the basement stairs in the home I’ve lived in for 14 years.
Dr. Jesse Fann: So, for somebody like Michele, she had some what we might call vulnerability factors prior to her brain injury, such as a history of depression, some substance use issues, that probably contributed to the likelihood of her having depression after her brain injury.
Michele Kauffman: The depression I experienced after my brain injury was the kind where I wanted to hide under the bed and wait for instructions. It was a lot more than being sad or crying a lot. I’d never met anybody that had a brain injury that hasn’t been sad and cried a lot. But this was to the place where you feel that everything you’ve done has been tragic, and you get in the mindset to where you’ll never do anything right again because you’re just not worthy. Many days, I was scared to get out of bed because I was afraid I would hurt myself.
Depression also caused Michele severe fatigue and intensified the physical pain she struggled with from the multiple surgeries on her skull. Eventually, she was prescribed an antidepressant medication by her doctor.
Dr. Jesse Fann: And what antidepressants do is they help to rebalance those natural chemicals in the brain called neurotransmitters to a more natural state and by doing so can help their mood get back to normal.
Dr. Jesse Fann: And how’s your mood been?
Michele Kauffman: It’s kind of hard trying to keep on top of my own mood.
Dr. Jesse Fann: Yeah.
Michele Kauffman: I’m tired of being sad and I’m tired of crying all the time.
Michele started with one drug that did improve her mood but caused unmanageable weight gain. The second drug she tried didn’t have that side effect.
Michele Kauffman: I’ve learned if you don’t like the depression medicine you’re on, it’s okay to ask to try another one. They do different things, and this is the one for me now. I didn’t think I needed it, but since I have, I’ve quit crying every day.
Michele also was greatly helped through regular walking and other forms of exercise. That’s something that’s been a long time coming for Brandon.
Brandon Blake: I went six months without being able to exercise at all. And so I had to build up to just being able to have that exercise be in my life and realize how much it was helping my brain injury by being active, that it was helping my brain just work better. My depression pretty much goes away when I exercise.
A combination of exercise, music, art, a loving relationship, strong community, and cognitive-behavioral therapy is Brandon’s treatment for his depression.
Dr. Jesse Fann: A multi-pronged approach to combating depression is really the best approach. Brandon is an excellent example of somebody who’s really pulled together a wide array of strategies to help himself out and also to let others help him out.
Brandon Blake: I have an awesomely unique opportunity to take my brain on this journey of healing and clear, intentional work. It’s not easy. It’s a daily struggle. It’s the hardest thing I’ve ever done. But it’s the most worthwhile thing I’ve ever done. It’s my brain. I only get one.
Traumatic Brain Injury Model Systems provide coordinated and multidisciplinary care and conduct research to improve care and outcomes for people with traumatic brain injury.
This video is a product of the Model Systems Knowledge Translation Center and funded by the National Institute on Disability and Rehabilitation Research.
To learn more about the work of the Traumatic Brain Injury Model Systems, please visit MSKTC.org.
Visit https://msktc.org/tbi and get the answers you need from experts who conduct innovative and high-quality research, provide patient care, and work to improve the health and overall quality of life for people with traumatic brain injury. That’s https://msktc.org/tbi.