By Eliza Marie Somers
Is the depression, anxiety and lack of motivation a result of a brain injury or is it a mental health disorder? That question can be tricky to answer for many brain injury survivors as grief over loss of self-identity and purpose can set in after a head injury, leading to depression and other mental health issues.
A panel of health-care providers discussed possible avenues to identify the cause of these issue along with pathways to recovery during the February 9, 2024, Brain Injury Hope Foundation’s Survivor Series: Addressing Brain Injury, Mental Health and Substance Use Disorder (Addiction).
The panel participants:
- Rachel Michaud, PA-C
Family Care Center
13402 W. Coal Mine Ave., Suite 110
Littleton, CO 80127
Office: (303) 248-7894
Fax: (303) 845-8814
Email: [email protected]
Website: www.fccwellbeing.com
- Danielle Neva Meyer, DSS, BSP
Brain. Body. (Re)balance
www.danielleneva.com
(720) 454-6453
- Lindsey Frazier-Gross, Psy.D. ABPP-CN
Craig Hospital
“I think the primary care physician is the first step,” neuropsychologist Lindsey Frazier-Gross said, “Get a good medical workup. It’s important. There are some things that correspond with a brain injury that can make mental health worse, such as sleep apnea or a vitamin deficiency. The first step is to get the right guidance to tend to all these different things.”
Lindsey Frazier-Gross says it’s important to get a “good medical workup” to determine if symptoms are related to hormonal issues or a vitamin deficiency.It’s also important to look at the chemical changes in the body after a brain injury, including hormone and thyroid functions. For more on TBIs and hormone function
However, Frazier-Gross said: “It’s all integrated. What is a mental-health piece and what is a result of a brain injury? It’s multi-focal.”
After a brain injury the neurotransmitters can be damaged and changes in biochemistry can cause disruptions in sleep cycles and the endocrine system.
“And sometimes it’s the coping adjustment piece,” she explained. “Is the depression from a chemical imbalance or is depression from the brain injury, such as loss of identity and functioning. It’s an overlapping system, and I don’t think it matters. There’s a lot treatment modalities available.”
The No. 1 thing a TBI survivor can do is improve their sleep, Frazier-Gross said. “Sleep is so important to our mental health and cognitive health. It is the foundation for a healthy brain. Get good sleep, get restful sleep, treat any sleep disorder. And then you might have a better sense if it’s more than a biological issue.”
Brainspotting specialist Danielle Neva Meyer said it’s not necessary to separate what might be a symptom of the brain injury and what might be a mental health disorder.
“It blurs together – all are part of the brain. They are tied together,” Neva Meyer said. “The big thing is to start getting that help. If you have trouble sleeping, it’s going to be harder to heal. Taking care of that piece might make you feel better. Get some exercise to settle the parasympathetic nervous system to calm down.”
“It all seeps together,” said Rachel Michaud, a physician’s assistant at Family Care Center in Littleton, CO. “A lack of motivation may come from the TBI. Then you develop depression, so you use substances, and since you are using substances there’s a lack of motivation. You see this loop, and it’s hard to get out of it. I absolutely seeing these coexisting together.”
Michaud also noted she sees numerous patients who are self-medicating.
“I really encourage people to stop self-medication – to give yourself the best possible help,” she said, especially if a prescription medication is involved with patient care. “See how taking the medications feel.”
When treating clients who suffered a brain injury, Fraizer-Gross said, “I like to think about how the brain functions and what parts of brain are injured. Then it can contrast with depression and anxiety. Are there personality changes – impulsivity, loss of filters … where mental health effects are more on mood or dysregulation. … I like to talk to patients on how they think and feel, and how it is showing up – such as inactivity. And with substance abuse – is there a prior history. After a brain injury there is less ability to cope, to regulate or to avoid substances – and it can be worse.”
Alternative Treatments
Neva Meyer is a brain injury survivor. She became a certified brainspotting therapist after experiencing success with the treatment.
“Brainspotting is so deeply healing and so gentle it really got to some of the trauma areas and really allowed the other modalities that my other practitioners were using to treat me to go more deeply. I saw it was so helpful I decided to pursue it,” she said.
Danielle Neva Meyer became a brainspotting therapist after the treatment helped her in recovering from a brain injury. Brainspotting is a trauma release therapy that has its roots in EMDR – Eye Movement Desensitization and Reprocessing. However, with EMDR the therapist is the one in control, whereas in brainspotting the patient is the one who facilitates the therapy.
Brainspotting and EMDR both help to locate a point in someone’s visual field to access the trauma that is deep in the brain.
“It has to do with the flight or fight response,” Neva Meyer explained. “It’s a brain-based tool that really taps into the body’s self-healing ability. It’s gentle, but it’s deep work. It can be integrated with any number of modalities.
“When the body is in a state of trauma, it’s hard to heal. It works with the brain’s neuroplasticity. It basically unlocks the memory part of the brain with a trauma pathway into the body. Sometimes in an accident all these chemicals flood into your body from your brain stem, and that gets trapped in a pathway. That memory gets created, and it’s very hard to heal that just by talking about it. You have to go deeper in the brain to release it. … (Brainspotting) helps process trauma, calm the system and helps you get out of this escalated state that comes with a brain injury.”
Neva Meyer note that brain injury survivors can get fatigued and overwhelmed when it comes to all the therapies that are out there.
“Work with your doctor on what’s your biggest goal. What is the most acute thing you need to address? And not try to hit everything at once, but narrow your scope a bit, and let your body start to integrate things,” she said.
Rachel Michaud say Transcranial Magnetic Stimulation increases the chemicals in the brain and allows for neuroplasticity.Transcranial Magnetic Stimulation is another therapy that is coming to the forefront.
“Basically, a magnet is placed on the head to treat depression, and it has benefits to treating TBI,” Michaud said. “This modality is so effective. Who knew treating with a simple magnet can treat so much. So, what it’s doing is changing the brain chemistry. It’s increasing the level of chemicals that are low in depression, PTSD, anxiety and bringing those to the surface, and it allows for neuroplasticity.”
Other alternative treatments for mental health issues include ketamine and psilocybin (magic mushrooms). However, Frazier-Gross said their use has NOT been studied with brain injury survivors.
“There’s still a lot of research that needs to be done, and hopefully we can do so and learn more about it. It’s pretty exciting so far,” she said.
Finding a Therapist/Counselor
Once a determination is made to seek mental health treatment, finding a therapist can be difficult for a brain injury survivor.
“There’s a huge barrier for individuals to seek care,” Michaud said. “But you have taken the hardest first step. …. There is absolutely nothing wrong with seeking help. It’s absolutely the best thing you can do for yourself. … Mental health awareness is on the rise especially after the pandemic. There’s a ton of resources, and family members can help by reaching out to different facilities.”
Having a therapist who you are comfortable with is crucial to care, Frazier-Gross said.
“The relationship is the most critical part of the work. It should be a good fit, a good relationship. One where you feel like you can be open and raw. So, you can get the benefit of the work,” she said. “If it’s someone you don’t like, it’ not going to be as effective. You might have to try several therapists, and it’s OK to try another therapist. That relationship is so powerful. It can take time, and that can be a struggle.”
Neva Meyer made the point that it takes research to find health-care providers who are a good fit. Ask other brain injury survivors for recommendations, seek out brain injury groups, such as Brain Injury Alliance of America, ask your PCP to find resources.
“It’s really important to network,” Neva Meyer said when seeking therapies and providers who are familiar with traumatic brain injuries.
