Concussion and Depression

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CONCUSSION AND DEPRESSION

There has been much discussion in the media and sporting circles again about the short and long term effects of concussion ( known medically as TBI – Traumatic Brain Injury) and mental health (depression and anxiety). These effects also apply to those who work in areas where physical injuries can occur (military, police, security for example).
It is known as Traumatic Brain Injury because of the damage that concussion produces. It is not just a knock to the head that you can “shake” off.

The well documented ongoing difficulties Australian cricketer Will Pucovski has experienced shines a light on these ongoing and long term effects of concussion. Will has had multiple concussions dating back to his earlier teen years.

Whilst avoiding injury is always the best approach, this maybe impossible. As Seinfeld famously stated , whilst “we continue our head cracking lifestyles”, concussions will happen.

So can you protect yourself against the effects of concussion?

The short term effects of concussion include headache, dizziness, memory loss, insomnia, sleep apnoea and difficulty in concentration. Whilst these usually disappear over time, there is increasingly justified concern about the long term effects, especially if multiple concussions occur.

Although the acute effects often resolve on 10-14 days, damaging secondary effects often persist, despite the appearance of a full recovery.

These include brain cell inflammation, alteration of blood flow within the brain, diminished energy production within the brain, and a damaged “leaky “ blood brain barrier ( designed to keep damaging substances out of the brain and transport vital compounds in).

Unfortunately the brain is not designed to control inflammation very well. (it has much less capacity than most other areas of our body).

Even more disturbing is the high rate of pituitary gland function loss. Over 50% of sufferers develop pituitary hormone deficiencies 1 year after concussion. (The pituitary gland is responsible for controlling the production of thyroid, stress, inflammation and sex hormones).

The damaging effects on the pituitary gland further impairs the ability of the brain to heal.

Although research is on-going it appears that these concussions can be a cause of neurodegenerative conditions such as chronic depression, fear, anxiety, memory and concentration loss, chronic mood changes, Alzheimers, other dementias and Parkinsons disease. The likelihood of these effects increases with the more concussions experienced.

These concussions may be minor, or more dramatic, but the cumulative effects also appear to be a concern, even in minor concussions. One previous concussion makes any subsequent concussions more damaging than they otherwise would have been (known as second impact syndrome).

Alarmingly, younger people, with a still developing brain may be uniquely susceptible to the effects of concussion.

A recent study highlights these dangers, especially in younger people. A study using brain MRIs in young teen ice hockey players revealed that “changes in brain function and brain region connectivity persisted well after players’ clinical assessment scores had returned to normal and they had been cleared to return to play. Ongoing white matter maturation may make adolescent athletes particularly vulnerable to brain injury, and they may require extended recovery periods. The consequences of early brain injury for ongoing brain development and risk of more serious conditions such as second impact syndrome or neural degenerative processes need to be elucidated”.

The study showed persistent MRI-detectable neuronal changes that reflect long-lasting damage to white matter fibres and compensatory recovery mechanisms.

This highlights that adverse effects are still occurring within the brain, despite a seemingly normal return to activities and without a full recovery, players may have increased susceptibility to injury and may be at risk of serious conditions such as second impact syndrome. So often people are returning to sport or work before their brain has fully recovered.

It also appears , along with many other neuro-degenerative and mental health conditions, that some people are genetically pre-disposed to the ill effects of concussion.

Can you reduce the ill effects, both short and long term, from concussion?

Can you reduce the effects of concussions events?

Can you improve recovery?

The answer is YES to all of these questions.

Various medical trials of currently available prescription medications have been disappointing, showing no treatments that improve neurological outcomes after concussion, The 2016 Berlin Consensus statement on concussion in sport stated that “concussed athletes should not be taking any pharmacological medications that may mask or modify the symptoms”.

But there are other avenues available which do show promise.

Various herbs, nutritionals and even dietary interventions have been shown in some human and many animal studies to produce substantial improvements.

These include the herbs
Curcumin (turmeric) – enhanced absorption forms, Boswellia, Bupleurum, Bacopa, Ginkgo, Rosemary.

Nutritionals including DHA, resveratrol, tocopherol/tocotrienols, creatine, acetyl-L-carnitine, ubiquinol, N-acetyl cysteine, Magnesium, Vitamin D, lipoic acid, palmitoylethanolamine, NAD, quercetin, MCTs.

It also appears that diet can play a role in both reducing the ill effects of concussion and speeding up recovery.

Dietary choices that have been shown to reduce Alzheimers offer a sensible approach to reduce the risk of adverse effects from concussion, including the mediterranean MIND diet and versions of a ketogenic diet.

Animal studies have shown a high fat AND sugar diet worsened outcome after traumatic brain injury and that calorie restriction improved resilience to the effects of brain injury.

Whilst athletes may not want to employ calorie restriction, some supplements mimic the effects of calorie restriction and would be expected to offer the same protection. Calorie restriction works by increasing the activity of specific genes that promote neuronal growth and repair.

These benefits are not surprising as they are working in ways that have been shown in research in other and neurological conditions involving inflammation. These benefits can help improve resilience to injury, concussion and improve recovery afterwards.

Treatment

I always employ combinations that are synergistic, to address the variety of disturbances occurring in the brain after concussion.

Treatment should always be individualised and take into account a persons health history and medical situation. The benefits of taking targeted high quality supplements, at therapeutic doses along with specific dietary interventions can ensure the best recovery possible and also reduce the effects of future concussions.

I have successfully treated many people who have had concussions as a factor in their mental health problems. This includes depression and anxiety, but also Schizophrenia, bipolar and ADHD.

A current client in his mid 40s, having suffered 3 concussions (1 as a child and 2 in his early 20s as result of motor vehicle accidents), had a laundry list of diagnoses (Bipolar, Depression, anxiety, ADHD amongst others) and medications.

These conditions did not develop until after his concussions, in his mid 20s.

He has responded very well to his treatments thus far and is making “remarkable progress”. (his words).

Book a consult with Craig today on 8271 1827.

Craig has a special interest in mental health, autoimmune conditions, chronic fatigue and chronic viral infections.

References
Neurology. 2017 Nov 21; 89(21): 2157–2166.doi: 10.1212/WNL.0000000000004669 PMCID: PMC5696642 PMID: 29070666 Multiparametric MRI changes persist beyond recovery in concussed adolescent hockey players Kathryn Y. Manning, MSc, Amy Schranz, BMSc, Robert Bartha, PhD, Gregory A. Dekaban, PhD, Christy Barreira, BSc, Arthur Brown, PhD, Lisa Fischer, MD, Kevin Asem, MD, Timothy J. Doherty, MD, PhD, Douglas D. Fraser, MD, PhD, Jeff Holmes, PhD, and Ravi S. Menon, PhD.

Agha A – The natural history of post-traumatic hypopituitarism: implications for assessment and treatment (Abstract) https://www.ncbi.nlm.nih.gov/pubmed/16378796

Mychasiuk R – Diet, age, and prior injury status differentially alter behavioral outcomes following concussion in rats (Abstract) https://www.ncbi.nlm.nih.gov/pubmed/25270295

Mychasiuk R – Dietary intake alters behavioral recovery and gene expression profiles in the brain of juvenile rats that have experienced a concussion https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318392/pdf/fnbeh-09-00017.pdf

Liu Y – Short-term caloric restriction exerts neuroprotective effects following mild traumatic brain injury by promoting autophagy and inhibiting astrocyte activation (Abstract) https://www.ncbi.nlm.nih.gov/pubmed/28495608

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Acta Pharmacol Sin. 2017 Feb;38(2):168-181. doi: 10.1038/aps.2016.130. Epub 2016 Dec 26. SIRT1 plays a neuroprotective role in traumatic brain injury in rats via inhibiting the p38 MAPK pathway. Yang H1,2, Gu ZT1,2, Li L1,2, Maegele M3, Zhou BY2, Li F1, Zhao M2, Zhao KS2

Neurochem Int. 2015 Aug;87:85-91. doi: 10.1016/j.neuint.2015.06.003. Epub 2015 Jun 6. Alpha lipoic acid inhibits neural apoptosis via a mitochondrial pathway in rats following traumatic brain injury. Wei W1, Wang H2, Wu Y3, Ding K3, Li T3, Cong Z3, Xu J3, Zhou M3, Huang L1, Ding H1, Wu H3

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Brain Behav Immun. 2012 Nov;26(8):1310-21. doi: 10.1016/j.bbi.2012.07.021. Epub 2012 Aug 3. Administration of palmitoylethanolamide (PEA) protects the neurovascular unit and reduces secondary injury after traumatic brain injury in mice. Ahmad A1, Crupi R, Impellizzeri D, Campolo M, Marino A, Esposito E, Cuzzocrea S.

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Mol Med Rep. 2018 Jun;17(6):7859-7865. doi: 10.3892/mmr.2018.8801. Epub 2018 Mar 28.Quercetin protects rat cortical neurons against traumatic brain injury. Du G1, Zhao Z2, Chen Y1, Li Z1, Tian Y1, Liu Z1, Liu B1, Song J1

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