Psychiatric Symptoms After a
Traumatic Brain Injury
Traumatic brain injury (TBI) can affect people in very different ways. Some individuals continue working and functioning independently, but feel that concentration, emotional regulation, stress tolerance, and mental stamina are not what they were before the injury. Others experience more obvious changes in personality, behavior, mood, motivation, and day-to-day functioning that significantly affect relationships and independence.
Concussion is another word for mild TBI. The medical term "mild" TBI refers only to how long loss of consciousness or confusion lasted at the time of the injury—it does not mean that everything is fine and that no treatment is needed. Many people with mild TBI/concussion experience changes in emotions and thinking that significantly affect how they feel and function.
People with moderate and severe TBI may have spent time in the ICU, may sometimes have difficulty walking and talking, and may have medical complications from the TBI or other injuries they had at the same time. These experiences can affect post-TBI symptoms and recovery.
On this page:
Common symptoms after a TBI
Brain injuries can affect mood, thinking, personality, behavior, and sleep. These are not simply emotional reactions to stress or to going through a frightening event. In many cases, they reflect direct changes in brain function caused by the injury itself. How much a TBI affects psychiatric functioning doesn’t depend on how severely it affected physical functioning—a TBI can affect one area much more than the other.
At the same time, emotional reactions to trauma, disability, chronic pain, life disruption, loss of independence, and changes in identity can also play an important role. In many individuals, these physical and emotional factors become closely intertwined.
People can have a wide variety of symptoms after a TBI, including:
-
Depression
-
Anxiety
-
Irritability
-
Mood swings or trouble controlling emotions
-
Intrusive memories of the trauma
-
Loss of motivation or initiative
-
Fatigue
-
Sleep problems
-
Trouble thinking as clearly as before
-
Difficulty concentrating
-
Memory problems
-
Slowed thinking
-
Difficulty planning, organizing, or following through on tasks
-
Difficulties in distinguishing what is real from what is not
-
Changes in personality or behavior
Some people mainly struggle with subtle cognitive inefficiency or emotional exhaustion that others may not notice. Others experience major changes that are very apparent to family members and significantly affect relationships, work, judgment, or independence.
Cognitive and emotional symptoms can affect one another
Traumatic brain injuries can affect many aspects of thinking, including attention, concentration, memory, thinking speed, talking, planning, and organization.
These cognitive symptoms can make it harder to cope with stress, regulate emotions, participate fully in treatment, or maintain the same level of functioning as before the injury. At the same time, anxiety, depression, PTSD symptoms, poor sleep, and chronic stress can further worsen concentration, thinking, and memory.
As a result, emotional and cognitive symptoms often become deeply interconnected after TBI.
Cognitive problems from TBI can take different forms. Some people notice that while they can still technically do the things they used to, everything takes much more effort than before. Other people might not be able to work, go to school, or live independently.
Depression, anxiety, and PTSD after TBI
Depression is one of the most common psychiatric conditions after TBI. Symptoms can include sadness, trouble feeling happy, hopelessness, fatigue, irritability, lack of activity, and loss of interest in things.
Depression after TBI is more than just a reaction to the stress of dealing with a significant injury. The injury itself can disrupt brain systems involved in mood regulation.
Traumatic brain injury can also increase the risk of anxiety disorders and post-traumatic stress disorder, since the events that can cause TBIs—such as car accidents, assaults, and falls—are often frightening and scary.
Even when people don’t remember the events of the TBI clearly because they lost consciousness when it happened, they can still develop PTSD. In fact, not being able to consciously remember and rationally process the traumatic event can lead to fear and anxiety and difficulty coming to terms with what happened.
Loss of motivation is not always depression
TBI can cause a decrease in activity levels and loss of motivation, which is called apathy. Apathy can involve:
-
Loss of motivation
-
Reduced emotional expression
-
Spending much of the day inactive
-
Difficulty initiating tasks independently
-
Less interest in activities or social interaction
Apathy frequently causes much more distress to family members than to the person with the TBI. Loved ones may feel frightened, hurt, or confused by what seems like emotional withdrawal or loss of interest in relationships and daily life. Families sometimes worry that the person is giving up, being lazy, or doesn’t care about other people any more. However, individuals experiencing apathy after TBI often do not describe themselves as sad or emotionally distressed. In fact, they may say they feel perfectly fine.
Apathy after TBI is caused by damage to brain networks involved in motivation, initiation, and emotional engagement—not by a deliberate choice or lack of caring. Understanding this can help reduce guilt, anger, and misunderstandings, and develop strategies to encourage activity.
Personality and behavior changes
Some people experience major changes in personality, emotional regulation, or behavior after brain injury. They may become:
-
More emotionally reactive or emotionally withdrawn
-
More irritable
-
Less socially filtered
-
Less able to think through consequences before acting
Families sometimes report their loved one seems like a different person now. In some situations, the person experiencing the symptoms has only partial awareness of the changes, while family members notice them very clearly. This happens because brain injuries in certain locations directly affect the systems involved in self-awareness and monitoring one’s own functioning. These symptoms can be frightening and emotionally painful for both patients and loved ones, but meaningful improvement is often possible.
Hallucinations, strange beliefs, and unusual experiences
After TBI, some individuals may see or hear things that aren’t there, or develop unusual beliefs such as thinking people are spying on them or trying to harm them.
Sometimes, damage to brain injury networks involved in body awareness and processing information from the environment can cause symptoms that look psychiatric but actually represent problems with thinking and memory: for example, not realizing that one side of their body is weak, thinking family members have been replaced by imposters, or not noticing things off to their left. These symptoms can be confusing and emotionally overwhelming for individuals and families.
Our approach to TBI
Many symptoms after TBI lie at the intersection of psychiatry, neurology, and cognition and often do not fit neatly into just one category. As a neuropsychiatrist, Dr Byars uses her combined training in psychiatry, neurology, and thinking/memory disorders to fully assess symptoms and functioning, and to work with you to achieve your goals.
Depending on the situation, treatment may include:
-
Medications
-
Psychotherapy
-
Structured lifestyle strategies
-
Strategies to increase healthy activities such as exercise, good sleep, and social connection
-
Family education and support
-
Coordination with neurologists, therapists, rehabilitation clinicians, and primary care clinicians
Unfortunately, research on psychiatric treatment after TBI remains limited, and many treatments commonly used in general psychiatry have not been studied extensively in individuals with brain injuries. As a result, treatment often requires thoughtful individualization and ongoing adjustment over time.
People with TBI are often more sensitive to medication side effects, especially medications that impair memory, alertness, and cognitive functioning. Some medications commonly used for sleep, anxiety, headaches, bladder symptoms, or other medical problems can unintentionally worsen cognition, fatigue, or overall functioning; so it is particularly important to avoid them in TBI.
We work closely with you to choose the right treatment for your particular situation, taking into account where you are now and where you would like to be.
Family involvement
If family members or caregivers are involved in your healthcare, we’re happy to work with them as part of your team.
Family members often notice changes that are difficult for the person with TBI to fully recognize or describe, particularly when cognitive and neurologic symptoms affect communication. Family participation can help us better understand changes in:
-
Personality
-
Motivation
-
Emotional regulation
-
Day-to-day functioning
-
Memory and thinking
-
Changes in symptoms over time
Meaningful psychiatric care remains possible even when cognitive symptoms make it difficult to provide a complete history or participate extensively in visits.
There is hope after TBI
Recovery after TBI is often gradual and uneven rather than a simple straight-line improvement. Many individuals continue to improve over months or years—there is no cutoff where improvement always stops. Even individuals with significant psychiatric or cognitive symptoms are often able to return to work, maintain relationships, and rebuild meaningful lives after injury.
Who can benefit from specialized TBI care?
You may find our approach helpful if you or a family member are experiencing:
-
Persistent emotional or behavioral changes after concussion or TBI
-
Memory or concentration problems
-
Personality changes
-
Difficulty returning to work or usual daily functioning
-
New depression or anxiety after head injury
-
Hallucinations, paranoia, or unusual experiences after neurologic injury
-
Complex combinations of psychiatric, cognitive, and neurologic symptoms
-
Situations where it is unclear whether symptoms are primarily psychiatric, cognitive, neurologic, or medically related
If you have questions about whether this type of comprehensive care may be helpful for you or a family member, we’re happy to talk through your situation and help you think about next steps.
You can schedule a free 15-minute phone call to help you decide whether BayLight Psychiatry is the right fit for your needs.