From the Guidelines
Post-concussion mood changes should be managed with a combination of rest, gradual return to activities, and targeted non-pharmacological interventions, as recommended by the most recent and highest quality study 1. The management of post-concussive syndrome (PCS) related mood changes involves a multi-faceted approach. Initially, ensure adequate rest for 24-48 hours after the concussion, then gradually resume normal activities as tolerated. For mild mood symptoms, non-pharmacological approaches are preferred, including:
- Regular sleep schedules (7-9 hours nightly)
- Stress management techniques like deep breathing or meditation
- Light physical activity as tolerated Cognitive behavioral therapy (CBT) can be particularly effective for managing depression, anxiety, and irritability following concussion 1.
For more severe mood disturbances, medications may be considered, but the current evidence 1 suggests that non-pharmacological treatments should be the primary approach. If medications are necessary, SSRIs like sertraline or escitalopram can help with depression and anxiety, while short-term use of melatonin may be beneficial for sleep disturbances. It is essential to avoid benzodiazepines if possible due to their potential cognitive effects 1. Most post-concussion mood symptoms improve within 2-4 weeks, but some patients may require treatment for 3-6 months. These interventions help by addressing the neurochemical imbalances and neural network disruptions that occur after concussion, promoting neuroplasticity and recovery of normal brain function.
From the Research
Management of Post-Concussive Syndrome (PCS) Related Mood Changes
- The management of PCS related mood changes relies on identifying underlying symptom generators and may involve a combination of treatments, including sub-symptom threshold aerobic exercise, cervical physical therapy, vestibular therapy, vision therapy, cognitive rehabilitation, cognitive behavioral therapy, pharmacological management, or a combination of treatments 2.
- Post-concussive depression is a common complication of concussion, and its diagnosis can be challenging due to overlapping symptoms with clinical depression 3.
- Selective serotonin reuptake inhibitors (SSRIs) have been shown to improve recovery after stroke, including reducing dependency, disability, and neurological deficit, as well as improving depression and anxiety symptoms 4.
- SSRIs are recommended as first-line treatment for depression in patients with traumatic brain injury (TBI), including those with mild TBI, due to their potential benefits and robust placebo effects 5.
- The use of SSRIs for functional recovery after stroke has been proposed to be similar to the critical period of plasticity in development, and may enhance experience-dependent plasticity in perilesional tissue 6.
Treatment Options
- Cognitive behavioral therapy (CBT) may be effective in managing PCS related mood changes, particularly in conjunction with other treatments 2.
- Pharmacological management, including SSRIs, may be used to treat depression and anxiety symptoms in patients with PCS 4, 5.
- Alternative or adjunctive medications may be considered if the initial treatment does not achieve a depression remission 5.
Considerations
- The diagnosis of post-concussive depression can be challenging due to overlapping symptoms with clinical depression, and clinicians should be aware of the potential for greater emotional distress in patients with concussion 3.
- The use of SSRIs in patients with TBI, including those with mild TBI, is not a contraindication for antidepressant therapy, and health providers should routinely screen and initiate treatment for depression after TBI 5.