Biopsychology (Refer to instructions below)

Literature Review

Major depression disorder can have a variety of causes ranging from both environmental and genetic(Jorge et al., 2004). Among the most common environmental factors noted through research is the history of traumatic brain injury. This literature review will explore traumatic brain injury and the research evidence that relate it to the development of major depression disorders in a variety of groups in the population. The research evidence will be used to explore deeper the association that exist between the two and hence assist in the main diagnostic and management decisions for major depressive disorder.

Major depressive disorder is one of the very common psychiatric disorders characterized by extremely depressed moods and inability to normally perform physically, mentally and even socially(Moldover, Goldberg, & Prout, 2004). Anhedonia, suicidality, feelings of guilt, changes in sleep patterns and irritability are some of the cardinal symptoms of the disease. These symptoms according to mental chemistry research relate to either a disruption in the nervous system or the chemical balance in the brain. In the DSM-V Anxiety symptoms such as irrational worry, tension and fear are also proposed to be indicative of a depressive disorder. Some of the major causes of the depressive disorder are substance abuse, medical and terminal illnesses, traumatic events and other psychiatric disorders such as schizophrenia(Maller et al., 2010). However, research relating traumatic brain injury to the development of depressive disorder is existing.

According to the historical data on traumatic brain injury, the first survivor of TBI was a gas construction worker in 1848(Morissette et al., 2011). He survived an accident whereby an iron bar penetrated his skull severely damaging the frontal lobe. According to the clinical evidence of the follow-up, the patient experienced several physical and personality variations as he recovered(Seel, Macciocchi, & Kreutzer, 2010). First, he started being negligent of personal hygiene and health; he then started being irreverent and irresponsible. These changes were medically related to the inability of the brain to function normally following the injury. In a case study including such events later. Vasterling et al. (2012) described the resultant disorder as traumatic insanity and used behavioral disturbances, alteration of consciousness, and neurological symptoms to characterize it(Vasterling et al., 2012).

Traumatic brain injuries can take different forms depending on the severity and the extent of penetration of the injury(M.M. & R.B., 2014). These two factors directly determine the clinical history and the manifestation of the injury. Glasgow Coma Scale is a widely accepted measure of this severity and can classify brain injury as mild (score 13 to 15), moderate (score 9 to 12) and severe (score 3 to 8). Amnesia and loss of consciousness have also been widely used to determine the severity and extent of brain injury. However, the occurrence of depression following brain trauma has been found to be significantly unrelated to the severity classification. According to research conducted by only 23%of the patients who developed depression after brain injury had lost consciousness during the injury(McAllister, 2009). In addition Hibbard et al. (2004) indicates that loss of consciousness during traumatic brain injury may be protective and helps reduce the manifestation of major symptoms later in life(Hibbard et al., 2004). This, therefore, indicate that with the loss of consciousness, the brain is likely to repair faster and depressive disorder is less likely to occur.

According to Fenn et al. (2014), major depression is a cardinal sequel in survivors of traumatic brain injury. The researcher identified that the incidence of major depressive disorder after brain injury is at the rate of 13 to 35.5% with a prevalence of 17.8 to 62%(Fenn et al., 2014). However, an observation from this research is that the depressive characteristics being studied could vary with time and may have been indicative of stressing situations that are exaggerated to clinical level by the patients being observed (Hawthorne effect)(Bailey, Segrave, Hoy, Maller, & Fitzgerald, 2014). In additionOwnsworth and Oei(1998), observes that it is quite difficult to distinguish between the symptoms of depression from the expected effects of traumatic brain injury(Ownsworth & Oei, 1998). Lack of appetite, inability to concentrate and ease of fatigue are some of the overlapping symptoms that may result from trauma to the related brain centers of being associated with depression resulting from the injury.

In a different study, survivors of traumatic brain injury were clinically followed up for one year after the injury. In this follow-up, the manifestation of depression and related symptoms was observed and documented(Malec, Brown, Moessner, Stump, & Monahan, 2010). The researcher observed that in 87% of the patients, the depression symptoms appeared within the first one month of the injury. The main symptoms during this time were anxiety, inability to feed, disturbed sleep pattern and low mood. However, the researcher observed that although the manifestation of these symptoms significantly reduced in all the patients by the second month, 58% of the patient reported the return of bad mood and disinterest in activities by the eighth month after the injury(Goverover & Chiaravalloti, 2014). This evidence indicates that even after the direct effects of trauma and injury were healed by the first month, some of the patients developed depressive disorders later in the same year. These late manifestations cannot be related to the direct effects of the injury but are clinical symptoms of depressive disorder following traumatic brain injury.

From the perspective of a prospective study that analyzed clinical and neuropsychological manifestations of depressive disorder following a traumatic brain injury, it is clear that there is a relationship between the manifestation of depressive disorder and trauma in the brain(Schofield et al., 2006). In this experiment, MRI images of the brain were used to study the changes in the brain after a brain injury. One of the major finding in this research was that in more than 33% of the patients whose MRI were studied, a major depressive disorder manifested within the first one year after the injury. Comparatively, patients who had a history of traumatic brain injury manifested significant mood disorder and disorientation as compared to other patients who had injuries of similar severity but which did not involve the central nervous system(Skilbeck, Holm, Slatyer, Thomas, & Bell, 2011). This then proves that the manifestation of psychological disorder was majorly depressive and not the post-traumatic disorders. In addition, the patients had changes in the brain that would be seen through MRI that indicated that depressive activities were present in areas close to the injury part(Tanev, Pentel, Kredlow, & Charney, 2014).

The depressive disorder results from structural and chemical disturbances of the brain. This, therefore, means that when one consume chemicals and substances that disturb the chemistry of the brain, the manifestation of major depressive disorder are inevitable. In addition, when the brain tissues are disrupted, the same manifestations are likely to occur. Use of drugs and chemicals disturbs the chemistry of the brain causing imbalances that result to the depressive state of mind(Kreutzer, Seel, Gourley, & Jeffrey S. Kreutzer, 2001). Traumatic brain injury, on the other hand, destroys the brain cells causing leakage of chemicals and imbalance due to excess or deficient production of major neurotransmitters. This is the major cause of depression related to traumatic brain injury. This is the reason why with brain trauma, clinicians must be wary of the possibility of depressive disorders to occur as a long-term sequel(Hart et al., 2011).

As observed there is a wide variety of research evidence that supports the relationship between traumatic brain injury and major depressive disorders. The evidence is based on behavioral science and also on the physical manifestations and medical imaging. However, limited evidence supported by the chemical theory of depressive disorder is lacking and hence further research into this line is required.

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