Anxiety and Brain Injury: It’s Truly All In Your Head

– Posted in: Anxiety

Anxiety, Panic & HealthWe have this client.

His family says that he’s just not the same guy he’s always been. He’s extremely sensitive and gets angry at the slightest offense.

He can’t concentrate. His wife is frustrated because he can’t remember simple errands. Sometimes his mind wanders so much that he gets lost, or forgets what he was supposed to be doing.

Every day, he wakes up feeling overwhelmed by the idea of getting dressed, showered, and out of the house. Every night, he takes a sleeping pill. He has no appetite – food doesn’t taste good any more. He chugs Coke all day long, just to keep his eyes open.

He’s afraid of losing his job. He’s afraid of destroying his relationship. He struggles with self-esteem. And he’s convinced that there’s no way out.

So, what’s your first thought? Depression? Anxiety?

Did any of you think brain injury?

Two clients, same symptoms, different causes

The truth is, this isn’t one client. It’s actually two. One survived a pretty serious traumatic brain injury after falling off a roof. The other developed depression and anxiety after he lost his house to foreclosure and had to take a significantly lower paying job.

They use the same words and phrases to describe how they suffer. They share the same daily challenges and frustrations. Two distinct situations that ultimately meet on the same long and difficult path.

Perception is the key

However, the perception each man has of himself, the way he talks to his doctor, how his doctor responds, and the way each man approaches recovery? That is very different. One man is considered to have a physical injury in his brain – he sees a neurologist. The other is considered to have a mental illness – he sees a psychologist and a psychiatrist.

Even though they struggle with the same symptoms and daily challenges, their perception of how and why things are wrong changes everything.

Brain injury = Depression and Anxiety?

The person with a brain injury knows that there is something physically wrong. No one can see the small scar in his scalp, but he knows that the injury is there. What frustrates him is when his doctors talk about antidepressants and therapy – as if he had a mental disorder, and not a brain injury. He feels misunderstood and refuses to try anything.

The person diagnosed with depression and anxiety believes that his problems are mental. He senses that everyone thinks he can pull himself together, if only he would try hard enough. It frustrates him to hear his doctors talk about mindfulness and stress-reduction when he can’t get past the feeling that there’s something physically wrong with him. He feels like a failure for not getting better.

Stigma’s intersection between brain injuries and mental illness

Is the stigma of brain and mental health problems perpetuated because of the boundaries that come between medical specialties? The terms “psychological,” “neurological,” and “psychiatric” all live in the same zip code in the brain, so what exactly is the point of pigeon-holing each person? Is one man’s case solely neurological, and the other psychological? Let’s consider.

Chemical changes and physical damage in the brain

The traumatic brain injury client experienced an injury as a result of a physical force to his head. His brain suffered from major chemical changes and physical damage that destroyed some neurons, and forced others to re-route and compensate. These brain changes resulted in depression, anxiety, sleep problems, concentration and memory impairment, and fatigue. {{1}}

The client who experienced a traumatic loss and chronic stress also experienced major chemical changes in his brain. These chemical changes will eventually cause physical damage to parts of his brain, forcing some neurons to re-route and compensate. {{2}} These changes may be responsible for the depression, anxiety, sleep problems, concentration and memory impairment, and fatigue.

Physical damage to the brain due to depression and anxiety

That means there is probably a biological basis for his depression and anxiety. Could it also mean that some cases of depression and anxiety are a type of brain injury caused by trauma and chronic stress?

Scientists aren’t really saying so directly, but their research still supports the idea. Several studies show physical damage in certain areas of the brain of chronically depressed or anxious people. {{3}} {{4}} Other studies show that antidepressants can help generate new brain cells {{5}}, and promote the kind of chemicals (such as BDNF, brain-derived neurotropic factor) {{6}} needed to reverse brain damage – regardless of whether a person is depressed and anxious or not. {{7}} {{8}}

Depression and anxiety not mental illnesses?

What if we stopped calling depression and anxiety mental illnesses, and instead called them brain disorders? What if we went further and acknowledged that stress and trauma causes injury to the brain that results in symptoms such as depression, anxiety, sleep problems, and so on?

That shift in perception would equalize my two clients somewhat, and help explain why both of them suffer in such a similar way. They’re both struggling with a type of injury to the brain. They both might be treated for the resulting symptoms.

An imaginary conversation

I imagine a conversation between a patient and her general practitioner:

Patient: I lost my job several months ago, and my life has been incredibly stressful. I wake up feeling so worried and scared. I think about what I had and it makes me feel angry and sad to have lost it, and to be in this position now. I can’t stop thinking this way. I can’t sleep at night. I don’t even feel like seeing friends any more. It’s causing a lot of problems. I just don’t feel good. I don’t know how I’m going to pull out of this.

Doctor: It sounds like you might be experiencing a type of brain disorder caused by the trauma and stress of losing your job. Significant, long-term stress like you described, can cause physical damage to the brain. It’s no wonder it feels impossible to pull out of it – that kind of chronic stress can reduce your brain’s resources.

What I’d like to do is put you in a treatment plan that helps reverse the injury to the brain. Let’s start by talking about an antidepressant. We know that antidepressants regenerate brain cells, especially in parts of the brain that are vulnerable to stress. The antidepressant will also help increase certain chemicals in the brain that have been shown to reverse signs of depression and memory problems. It might also help you manage stress better. I have to warn you that it could take six to eight weeks before there’s any significant new brain cell growth, so you need to be patient.

Second, we need to start some cognitive and physical therapy for your brain. The cognitive therapy will help strengthen some of the brain functions you’ll need to better cope with stress. The physical therapy involves light cardiovascular exercise that will promote blood flow to your brain, and will also increase the brain chemicals that will help heal the damaged areas of the brain. I’ll refer you to two specialists, but I want you to start both therapies at a slow pace. You don’t want to overtax your brain too soon. Work up to it slowly.

Most importantly, we need to address your sleep. Your injured brain can’t heal unless it has plenty of sleep, so I’d like to start you off with a sleep medication for now, and we’ll wean you off of it as you start to get better. I need to see you in four weeks to make sure you’re resting and things aren’t getting worse. In the meantime, be patient. This kind of stress-related injury is serious, and you need do as much as you can to support your brain’s recovery.

Openness to new ideas and a change of perception

This is just a theory. But remember, so is the idea that depression results from a chemical imbalance. We’re just not at a place in brain science that we can know anything for sure. So, we might as well be open to new ideas. {{9}}

If you viewed your depression and anxiety as a physical injury to your brain, would that change the way you see yourself and your illness? Would it change the way you talk to your doctors? Would you feel validated instead of misunderstood?

Could you more easily compare yourself to someone who had, say, a major knee injury? Would you be able to approach medication and therapy in the same way a person with a knee injury does—with a little more patience and endurance? Would your family and friends be more understanding?

Would you be kinder to yourself?

Marie RowlandMarie Rowland is a neuroscientist, writer, and patient advocate. She founded EmpowermentAlly to help promote patient empowerment in people who have mental illness or a brain injury. You can find her at EmpowermentAlly and you can help support mental health services at Fundable – EmpowermentAlly.

Marie is offering subsidized services to people with a mental illness on her EmpowermentAlly website. She has a special offer for Anxiety, Panic & Health readers – a thorough review of your mental health concerns, history and a 30 minute coaching session all for a $15 donation at the crowdfunding site Fundable – EmpowermentAlly.

Last Update: October 3, 2012

[[1]] Riggio, S. Traumatic. Brain injury and its neurobehavioral sequelae. Retrieved October 1, 2012 from [[1]]

[[2]] Djordjevic A, Adzic M, Djordjevic J, & Radojcic MB. Chronic social isolation suppresses proplastic response and promotes proapoptotic signaling in prefrontal cortex of Wistar rats. Retrieved October 1, 2012 from [[2]]

[[3]] Takahashi T, Yucel M, Lorenzetti V, et al. Volumetric MRI study of the insular cortex in individuals with current and past major depression. Retrieved October 1, 2012 from [[3]]

[[4]] Hettema JM, Kettenmann B, Ahluwalia V, et al. Pilot multimodal twin imaging study of generalized anxiety disorder. Retrieved October 1, 2012 from [[4]]

[[5]] Boldrini M, Hen R, Underwood MD, et al. Hippocampal angiogenesis and progenitor cell proliferation are increased with antidepressant used in major depression. Retrieved October 1, 2012 from [[5]]

[[6]] The best short introduction to Brain-derived neurotrophic factor can be found at Brain-derived neurotrophic factor [[6]]

[[7]] Kaplan GB, Vasterling JJ, & Vedak PC. Brain-derived neurotrophic factor in traumatic brain injury, post-traumatic stress disorder, and their comorbid conditions: Role in pathogenesis and treatment. Retrieved October 1, 2012 from [[7]]

[[8]] Lee MM, Reif A, & Schmitt A.G. Major Depression: A role for hippocampal neurogenesis? Retrieved October 1, 2012 from [[8]]

[[9]] To learn more about the history and current state of treatment for depression, read “Post-Prozac Nation” [[9]]

24 comments… add one
Debbie October 4, 2012, 10:09 am

The story on the front page of this blog has hit home with me so very deeply. I to deal with a major brain defect that now has me home on SSD.
The issue for us that live with it is so big, a sites like this one helps a lot. Keep up the good work.
If I could ask you one thing – Please fix the link at the bottom of the piece as I want to find out more.
Again keep up the good work as I go to read more.

Mike Nichols October 4, 2012, 10:12 am

Thank you for the complimentary comments about Marie’s post. It is indeed very informative and helpful to many people.

And thank you for pointing out the dead link. It has been corrected.

Getting better October 17, 2012, 12:14 pm

This blog is really interesting, a very good way to look at things. It’s very mind provokating and makes alot of sense. I feel mental illnesses would be seen and taken more notice of if they were called brain disorders cos people don’t seem to understand the term mental. To them mental is seen as if it’s all in the mind, made up. Thanks for posting this xx

April Nutter October 17, 2012, 6:30 pm

Hi Marie,
What a terrific article! I’m lying here in bed, the third day this week, as i read your article, found iny newsfeed this morning. I pretty much try to work on the assumption that maximum health for myself can be achieved through all those things you have suggested . Iam a bipolar sufferer. I have heard of those connections between psychology and neuroscience, but never put so elegantly in a small piece of writing. It is beautiful, practical and sensible. Thank-you.

Mental Development December 1, 2012, 11:42 am

Nice read! Thanks for sharing. I totally agree with all your points. We should never really worry about the things that we have no control of. Keep up writing interesting posts.

Olivia Martin June 5, 2013, 4:23 am

I basically want to say everything this response did. We must let worry go. It solves nothing, helps zero, and wastes potentially productive time.

Thanks again.


Edward March 11, 2013, 4:51 am

Just come across your site. Your articles are amazing. I learn a lot from your site. Just don’t know whether your site is work normally or not since I see the latest post which informs about the upgrade.

Susie April 8, 2013, 3:01 am

Interesting article Marie. I didn’t realize that antidepressants could generate new brain cells. I am always interesting in the biology verses psychology of depression or even if it is a combination of them.

clever June 8, 2013, 1:57 am


Mental Health Manhattan June 22, 2013, 10:07 am

Start talking to yourself in a gentle and calming way. You want to develop this habit even when you’re not experiencing anxiety. Positive, compassionate inner dialouge will enhance your self esteem and self worth in many ways. When you’re anxious and fear takes over it helps to have a gentle, loving voice by your side. Sometimes this is other people but you are the only person who will always be with you.

angielski Szczecin July 28, 2013, 6:24 am

Thank you for a very informative site. What else could I get that kind of info written in such a perfect means? I have a project that I am just now working on, and I’ve been on the look out for such info.

joe December 12, 2013, 7:24 am

Yes as your article its all about our mind if we lose it then we will lose life thanks for share with us

Mike May 14, 2016, 8:12 pm

Your article is right on!! I have had fronta tbi for 36 years and life does not get any better as far as anxiety. This is the worst thing that has ever happpend to me. I have severe anxiety in the mornings. I have panic attacks. you name it i had a seizure within 6 years of dealing with this nightmare. Be kind to the loved one who has to deal with tbi day in and day out. I also don’t remember alot of movies i watched the night before. i forget alot of things. That is what goes on for years and years. I hope you learn how to deal with a person with tbi. This is no fun. Good luck to the people that are dealing with this awful injury. God Bless!!! Mike

Zander May 18, 2016, 5:12 pm

Wow. That little discussion you created at the bottom of the article is really interesting and is probably one of the most hopeful ways anyone could describe depression to a depressed person. It’s so straightforward and objective, while still creating a feeling that there is something of worth in the future. No matter how well anyone can relate to a depressed person, I would imagine that could be the most surefire way to give hope and understanding.

addiction treatment New Jersey June 21, 2016, 10:32 am

We often use the expression ‘I feel depressed’ when we’re feeling sad or miserable about life. Usually, these feelings pass in due course. But, if the feelings are interfering with your life and don’t go away after a couple of weeks, or if they come back, over and over again, for a few days at a time, it could be a sign that you’re depressed in the medical sense of the term.In its mildest form, depression can mean just being in low spirits. It doesn’t stop you leading your normal life, but makes everything harder to do and seem less worthwhile. At its most severe, major depression (clinical depression) can be life-threatening, because it can make you feel suicidal or simply give up the will to live.

mental illness treatment New Jersey July 6, 2016, 10:28 am

Face your fears. Don’t avoid the things you find difficult. When people feel low or anxious, they sometimes avoid talking to other people. Some people can lose their confidence about driving or traveling. If this starts to happen, facing up to these situations will help them become easier.

Tom August 2, 2016, 8:09 pm

I have severe brain damage from a fall from 16 to 20 feet on the left side of my forehead and i have had severe anxieties ever since. I feel so bad for people with tbi!! I have been diagnosed with mild severe brain damage!! All the people that live with this should be treated with the up most respect!! Also since it happend over 35 years ago it never gets better!! I have tried it all. I just feel sorry for my family and wife that have to put up with this mess everyday!! We make plenty of money which is a good thing. but at the same time its a living hell to have to live like this. And the chronic pain that comes with it as well. The brain just tells the body that your hurt!! and therefore you live in chronic pain. Only if you have severe brain damage!!! I would rather break my leg or arm than live with this. I try to stay positive but its real hard. One thing is you never lose your IQ! After years of dealing with it Me personaly would rather die. its a hard lonley road that most people have no clue how you have to deal with it. good luck to all the people with severe frontal brain damage! Its a nitemare and only God keeps you alive. Because otherwise it should be dead. The anxieties are incredible. I just want to be given a pill that stops the anxieties for no reason!!!! I feel so bad for anyone that has to deal with frontal tbi the rest of there lives.It only get worse as far a memory and anxieties along with headaches the older you get. so if you fall on your head get help quick. don’t be like me and say it’s just sore and my body will get better!! because it like i said it olnly get worse with age!! Good luck with it because your life will only make a turn for the worst!!!!!!!!!!!!!!!!!!!!!!!!!!!!

PTSD treatment Morris County September 1, 2016, 9:09 am

Good mental health isn’t just the absence of mental health problems. Being mentally or emotionally healthy is much more than being free of depression, anxiety, or other psychological issues. Rather than the absence of mental illness, mental and emotional health refers to the presence of positive characteristics. Similarly, not feeling bad is not the same as feeling good. While some people may not have negative feelings, they still need to do things that make them feel positive in order to achieve mental and emotional health.

Zander September 1, 2016, 2:02 pm

Boom! This comment right here 10/10. You hit the nail on the head.

victor dowedoff March 11, 2017, 3:20 am

i had 5 mini strokes because of a disease that attacked my heart. the heart grew vegitation then it went into my brain and stopped some parts of my body from working and i had anxiety before this happened. now parts of my body do not work anymore and my anxiety level has gone to a level that has made me unsuccessfully to kill myself. during the course of my treatment, i developed kidney stones. this condition is extremely painfull. my doctor at the time prescribed to me demerol. it is a painkiller of considerable strength, however it did little for the pain that the kidneystones caused but i did notice a marked improvement in how my brain felt, so after the surgery was completed to remove the stones, i started to use the demerol for the brain pain and anxiety. this drug is a narcotic and can be addictive. i used it carefully taking a maximum of 3 pills a day but usually only 2 breaking them in half and taking the 4 parts morning noon supper and bedtime and i felt just as i felt before any of the anxiety or brain trauma ever happened. this went on for a year and a half. i ran out of the pills and went to the doctor to tell him what happened and i was labeled a drug addict. but there was one psyciatrist who perscribed them to me untill the college of pysicians and surgeons in canada told the doctors in alberta that if they were to prescribe these pills for anything other than severe pain, that they would have their licence revoked. now they won’t prescribe them unless you have cancer or being held at gunpoint [which i haven’t tried]. this brain injury anxiety pain and inability to function is horrible. when it comes to the point that it’s time to kill myself, i will be sure to take a few of these doctors with me

hoa tuoi dep May 9, 2017, 2:15 am

hanks for sharing. I totally agree with all your points. We should never really worry about the things that we have no control of. Keep up writing interesting posts.

Bryce August 6, 2017, 5:03 am

Antidepressants regenerate brain cells?

Antidepressants balance brain chemicals?

You can’t be serious! Where are you getting this information??

There is no way you are a neuroscientist. If you were you would not make such reduculious untrue statements.

Very dangerous to be publishing this kind of information.

Mike Nichols August 6, 2017, 6:33 pm

“Where are you getting this information?” Read the footnotes.

No, I’m not a neuroscientist. Read my disclaimer.

I am reporting publicly available scientific research by well-known scientists. If that’s dangerous, then every science magazine would have to shut down tomorrow.

Bruce Royer August 7, 2017, 6:02 pm

Hi Mike….No worries. Id like to provide you with some information that you might possibly include in your writings about mood disorders and mental health.

You mentioned you provide articels from scientific journels and articles. Please be very careful as to where the information is coming from and to make sure its valid. Even if it is an ‘Article” or printed in a scientific journel does not make it true.

I think its important to include information about the inefficacy of psych medications as well. So people can make wise choices before going down that road. I was severely harmed by these drugs and almost died from them. And so I did very deep research to find out the truth about these medications. I also found that mental health can be corrected safely by other natural therapies.

The truth about psych medications

I know you are just a writer trying to help people but please watch the above films so you can provide a balanced blog.

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