Mental health

Signs of potential mental health problems

It can be difficult to think about yourself and whether you’re experiencing mental health challenges. You may think you’re just fine, but others around you may notice changes they can’t explain.

Signs of potential mental health problems can include [1]:

• Changes in sleeping/eating patterns
• Changes in your mood
• Getting easily angered/being impatient
• Difficulty coping with stress
• Difficulty concentrating
• Changes in appearance
• Increased isolation
• Fatigue
• Changes in weight
• Hearing or seeing things that aren’t there

Your health care and support team will be able to help you figure out what is prompting your feelings and how best to manage them moving forward. Keeping a daily journal is an excellent way to provide your support team with the most accurate information about what you’re experiencing.

• Daily activities tracker

Difference between mental health and mental illness

It’s important to note that there is a difference between mental health and mental illness.

Mental health is also known as mental well-being. It refers to your emotions, thoughts, and feelings. Mental health is something many Canadians struggle with at some point in their lives. There are multiple factors that can contribute to mental health problems, including:

• Significant life change
• Relationships
• Isolation
• Physical health
• Age
• Gender
• Stress
• Trauma
• Employment

Mental illness is a diagnosed disorder that impairs how you think, feel, behave, or interact with others. There are many different mental illnesses which have different symptoms that impact peoples’ lives in different ways. Examples of mental illnesses include:

• Addiction disorders
• Anxiety disorders
• Eating disorders
• Mood disorders, like depression, bipolar
• Personality disorders
• Post-traumatic stress disorder
• Psychosis disorders, like schizophrenia

Studies have shown that individuals with a brain injury have a higher chance of developing a mental illness. A mental illness can only be diagnosed by a doctor/psychiatrist. While you may have symptoms of some of these disorders, that does not mean you have a mental illness – just like individuals with a diagnosed mental illness can experience good mental health. If you have any concerns or questions, speak with a mental health professional[2].

Mental health problems after brain injury

Some of the most common mental health/well-being problems experienced after a brain injury include:

Anxiety

Anxiety is feelings of worry and fear about the unknown. It is normal to experience some anxiety, especially as you recover from a brain injury and have new experiences – but it becomes problematic when you are unable to manage it, or it doesn’t match the situation. There are a few different types of anxiety you can experience[3].

General anxiety means you experience persistent and excessive anxiety over various parts of your life, including work and home life. You find your anxiety difficult to control and you may even experience physical symptoms including restlessness, fatigue, muscle tension and sleep disturbance.

With social anxiety, a person is fearful, anxious about, or avoids social interactions and situations that involve the possibility of being watched. This includes meeting unfamiliar people, situations where you’re eating/drinking, or situations where you may perform in front of others. Individuals worry about being embarrassed, rejected by others or of offending people.

If you experience social anxiety, this can lead you to staying in and isolating yourself. For tips on combating social isolation and anxiety, visit our social life and brain injury page.

Panic attacks

Panic attacks are abrupt surges of intense discomfort that reach a high within minutes. They are accompanied by physical/cognitive symptoms. They can be expected or unexpected. Expected panic attacks are connected to a typically feared item or situation. Unexpected panic attacks occur for no apparent reason.  Individuals who experience panic attacks are regularly worried about having more panic attacks. They may also change their behaviour to avoid attacks, which can impact them negatively (i.e. skipping exercise, avoiding new places). Panic attacks are often a sign that someone has an anxiety disorder. (Source: Diagnostic and Statistical Manual of Mental Disorders)

There are a few key ways you can identify them:

• Feelings of choking, chest pain, nausea, dizziness
• Feelings of detachment or unreality
• Heart palpitations
• Hot or cold flashes
• Numbness or tingling
• Shakiness or trembling
• Shortness of breath
• Sweating

A panic attack can be brought on by different things, but often happen when you’re feeling trapped or overly anxious about something. Some people spend a lot of time scared they may have another panic attack and try to isolate themselves or stick to ‘safe’ environments. This is difficult and impacts how you live your life.

Ways to cope with panic attacks include:

• Practice calm breathing
• Practicing body relaxation
• Identifying what may be starting your panic attacks
• Use positive visualization or a comment card
• Visit a therapist
• Slowly build up your tolerance to the things that start your panic attacks

It takes a lot of time and dedication but managing panic attacks is possible with the right tools.

Depression

In most cases, your abilities and sense of self changes after a brain injury. Adjusting to your new self and situation is difficult and can result in elevated stress and feelings of sadness, anger, loneliness, and depression. These emotions, including depression, are normal to experience as you go through the grieving process. Depression can also be caused by injury to the area of the brain that controls emotion, pre-existing genetic factors, and situational influences[4].

Symptoms of depression include:

• Changes in eating patterns
• Changes in sleep
• Changes in weight
• Feelings of sadness
• Focus on the emotions of loss and grief
• Helplessness, worthlessness and guilt
• Irritability Less interest or pleasure in things or activities previously enjoyed
• Loss of sexual interest
• Physical aches and pains
• Poor concentration
• Tiredness or loss of energy
• Thoughts of death and suicide
• Withdrawing from friends and family

Please note: You may have some of these symptoms and not have depression. Talk to your healthcare team about any emotional or physical symptoms you may be experiencing.

While it is normal to experience symptoms of depression after a brain injury, if you experience them for a long period of time or suspect that your depression isn’t related to grief, you should see a medical professional who can diagnosis depression. Extended periods of depression can have an impact on your recovery. You may be more fatigued, have trouble engaging with people, or find participating in rehabilitation more difficult. You also may have trouble recognizing when you’re depressed and not have the skills to cope with it in a constructive way.

If you are diagnosed with depression, the most common treatments for depression are prescribed medications and talk therapy. Some things you can do at home to cope with depression include[5]:

• Reduce substance use
• Following a balanced diet
• Engaging in physical activity
• Find enjoyable hobbies
• Getting an appropriate amount of rest
• Try mindful activities like meditation

Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a mental health disorder that occurs in people who have suffered a traumatic event. It’s common in individuals that have experienced assault, accident survivors, and people in the military. Symptoms of post-traumatic stress disorder include:

• Anxiety
• Increase in negative thoughts, feelings, and beliefs stemming from the trauma
• Disassociation – losing touch with the present and feeling like you are experiencing the trauma again
• Hallucination flashbacks
• Nightmares
• Avoidance of certain situations that may recall (trigger) the trauma
• Feeling on guard all the time
• Not remembering parts of the trauma
• Sleep problems

Not every person who suffers a traumatic brain injury will have post-traumatic stress disorder. Additionally, not everyone with post-traumatic stress disorder will have had a brain injury. It is dependent on the person, injuries, and how the trauma was processed. Only a licensed professional like a psychologist or psychiatrist can diagnose post-traumatic stress disorder.

• More information on post-traumatic stress disorder from Anxiety Canada

Treatment of post-traumatic stress disorder

Post-traumatic stress disorder can be difficult to cope with: you need a support team to help with ongoing, long-term management. Therapy and prescription medication are two of the most common ways to help treat post-traumatic stress disorder. Other things you can do at home include [6]:

• Attend public support groups – your doctor or therapist can direct you to one if it’s available in your area
• Exercise and taking care of your physical health
• Find activities that make you feel good
• Identify what triggers you. Try keeping a daily journal of your thoughts and activities to help with this.
• Limit substance use

Suicidal thoughts

After an acquired brain injury, you may experience lasting changes to your personality, abilities, relationships, and how you process information (including impulse control).  These changes are difficult to cope with, and can leave a person feeling alone, hopeless and angry. These and other factors like impulsive decision-making can lead to a higher risk of suicidal thoughts.  It’s important to remember that these thoughts and feelings can happen at any point after a brain injury. Even if you believe you’re doing better, it’s important to continue therapy and take care of your mental health.

Signs of suicidal thoughts include:

• Statements about dying or wishing to have died
• Isolation or withdrawal from others
• Intense feelings of hopelessness and helplessness

If you are experiencing suicidal thoughts, you should talk to your doctor or a mental health professional immediately. While it may be difficult, try to remember the following things:

You are not alone. There are always people to support you – it could be a friend, a family member, a professional, or someone on a help line.

This won’t last forever. Often a person feels like life has become unbearable, but with time and the right supports and treatment, the crisis can be solved and prevented. That’s why it is important you share what you’re feeling/thinking with members of your family, your healthcare team, and anyone else involved in your support.

There are helplines and crisis centres available across Canada you can call if you need immediate support.

Mental health resources

• Referral guide for the Centre for Addiction and Mental Health
• Find your Canadian Mental Health Association
• The Post Traumatic Stress Disorder Association of Canada
• The Canadian Mental Health Association
• Suicide Prevention Handbook

Helplines and crisis centres

If you need access to supports or crisis centres for your mental health, use this list of contact information to find a helpline for your area.