Depression or Sadness after Brain Injury – Understanding the Difference

Long before my 2010 brain injury, I had more than a nodding acquaintance with clinical depression. My earliest recollection of having a depressive episode was shortly after the brutal murder of my sister-in-law close to thirty years ago.

Having no real understanding about depression at the time, I wasn’t able to label it as such. I knew that I had trouble functioning, that small tasks seemed insurmountable – and the very thought of getting out of bed filled me with dread.

It was all too much.

As the years passed, I learned more about depression from my on-the-job training. While a bout of depression could come at any time, it was seasonal depression that I suffered from the most. And suffer I did. Every year, as the days got shorter here in New England, I knew what was coming, and it filled me with dread. By the time October came around, I was living in full-blown depression. If I was lucky, by March of the following year, my head might begin to clear just a bit.

My depression was as clinical as it gets. Overwhelming feelings of sadness? Check. Random thoughts that the world would be better off without me? You bet. A couple of half-hearted suicide attempts?  Shamefully, I must admit to these. There is nothing pretty or easy about depression.

It was a predictable cycle. For six months, I would suffer, and for six months, life had a semblance of normalcy. This went on for a couple of decades. Don’t get me wrong; I am not one who likes pain. I did all that I could to overcome this brutal cycle. I sought professional help, went to counselors over the years, and tried a few stints of medication. While these treatments brought slight relief, nothing proved sustainable. I had reached the point where I assumed that my lot in life was to live with depression for the duration.

Fate apparently had other plans. 

On November 11, 2010, I was struck by a car being driven by a newly licensed teenage driver. I had broken bones, bruises, and lacerations. My accident also left me with a traumatic brain injury. Based on the type of symptoms that I dealt with, especially early on, most of my brain injury was located in the frontal lobe part of my brain.

I have been depression-free since that day.  

Looking back to the middle part of the last century, surgical procedures on frontal lobes was one treatment for depression. While very much a high-risk procedure, there were documented cases of a lobotomy easing depression.

While I can only speak from a layperson’s perspective, it’s not a far stretch to say that my unexpected frontal lobe injury has had an unexpected, and wonderful side effect. Before my injury, I battled depression and had for decades. Since my injury, I have been virtually depression-free.  No medication, no professional help, no nothing – just a horrific accident.

To this day, I marvel at the fact that I can enjoy the coming of fall. Shorter days are now a novelty and not a reason for dread. And that late-summer anxiety, dreading what is coming, has dissipated.

While I can vividly remember what it feels like to be depressed, it’s only a memory. My experience has taught me that life with a brain injury is unpredictable. Many of my deficits have cleared up over the last few years. This year, my ability to feel cold has begun to return after a long and much-appreciated absence. It’s not a far stretch for me to be concerned that, as I continue to heal, my depression may return. While I am vigilant, I am not hyper-vigilant. 

Just under three months ago, my mom sustained her own brain injury in the form of a stroke, followed by two seizures. Early on, we were told that she could pass at any time. Today, she is stable, and in a nursing home, most of her life’s memories erased from her mind. It has been the most heartbreaking chapter of our lives, and the lives of those close to her.

I have been awash in sadness for a couple of months, leaving the time since Mom’s stroke one big blur. Sadness has defined almost every day, and somewhere inside, I began to wonder if my depression was making a comeback. Based on my past history, and the current challenges we face, it would be completely understandable.

But over the last couple of months, I have learned that there is a vast difference between sadness and depression. Depression meant that I was unable to function on a day-to-day basis. Sadness means that I can still function, though at a slower pace. Depression swallows you whole and takes away all hope. Sadness means that as difficult as life is, there are still rays of hope shining through. Depression told me that suicide was the answer to my troubles. Sadness reminds me that as a family, we are all experiencing loss, and those who are close to me need me like never before.

At first glance, sadness and depression may seem like they are related, but when you dig a bit deeper, they are as different as apples and zebras.

Life is difficult right now. I am not the only one experiencing sadness. Sadness is a normal reaction to what has befallen us as a family. But I need not do more than look back a few years to my life with chronic depression to realize that I am going to be okay and that we are all going to be okay.

Some may view a brain injury as a curse. It comes with challenges, but today I am grateful to the core, grateful that I can suit up and show up for those who need me.