Depression and Anxiety

Robert J. Hartke, Robert J. Hartke, Rehabilitation Institute of Chicago
Depression and Anxiety

Mental health problems such as depression and anxiety can accompany an illness. The following information includes information on signs, symptoms and treatment.

Symptoms of Depression

Depression is characterized by feelings of sadness, despair and discouragement. It often follows a personal loss or injury. It is not a sign of weakness nor does it represent a moral failing.

Sadness that lasts a long time and a loss of enjoyment in almost all activities are the central features of depression. Sadness is a symptom, but not the same thing as depression. Everyone is sad sometimes. The type of sadness that occurs in depression lasts all day or most of the day, every day for a long time (at least two weeks). Other symptoms include feelings of worthlessness or guilt, suicidal thoughts, loss of concentration, decreased energy, slowed thinking and movement, appetite loss and sleep problems.

It is important to remember that many of these symptoms can occur with illnesses such as brain injury or stroke or even less serious problems like a cold or flu, but may not indicate depression. Even if you have trouble sleeping, lack of appetite and problems concentrating, there is no reason to be concerned about a separate mental health condition unless you also feel sad most of the time or rarely find enjoyment in life.

What is the difference between normal grief and depression?
Some symptoms of depression as described above are normal after any kind of loss including the onset of a disability or severe illness. If you have had these symptoms for a long time it may be helpful to talk with a mental health professional. It is also helpful to talk to someone if you have other symptoms such as feeling guilty or worthless, or if sadness interferes with the ability to do important life tasks (take medication; go to therapies, work or school).

Symptoms of Anxiety

Following a major life-changing event like a disabling illness, it is normal to feel a great deal of stress. Stress can build up over time and can lead to anxiety. Anxiety can be a response to a specific situation such as learning to walk all over again; it can also be more generalized such as not wanting to leave the house after being discharged from the hospital.

The most common symptoms of anxiety are fear and worry. Anxiety can also cause restlessness, and difficulty concentrating and sleeping. Sometimes people will express anxiety by being irritable, tired or even stubborn. Anxiety can cause physical symptoms like muscle tension, shortness of breath or even feelings of panic. Nearly everyone feels anxiety when faced with a bad physical problem. Anxiety becomes a concern when these feelings are very strong and interfere with important tasks in life.

Can anxiety or depression be different depending on age?
Children and older adults often show anxiety and depression differently. Children may misbehave either at school or at home. Older adults might report vague physical problems when there is no clear medical cause.


Both depression and anxiety can go away over time but without treatment the symptoms last longer and may return. Chronic depression or anxiety can cause low self-esteem and poor quality of life.

Anxiety and depression are usually treated with medication and/or psychotherapy (counseling) by a trained professional. Treatment is usually quite successful, so there is little reason to delay seeking help.

If feeling anxious or depressed, it is important to admit to it and get help. Even when family and friends are around for support, professional attention is best. A good first step is to discuss concerns with your regular doctor. He or she can provide advice about the best treatment and suggest a qualified therapist. There are several types of mental health professionals who can provide psychotherapy (counselors, social workers and psychologists), but any medications must be prescribed by a physician (your regular doctor or a psychiatrist). It is important to select a therapist with whom you fee comfortable and can talk honestly about your feelings. Psychotherapy can be done individually, with other family members, or in a group.

Sometimes it is best to both take medication and see a therapist. Medications can be helpful in many cases. Sometimes people are afraid of acting and thinking strangely, or becoming dependent on drugs used to treat anxiety and depression. When these medications are taken as prescribed by a doctor, bad side effects can be reduced or eliminated and there is little risk of becoming addicted to them. Remember that these medications are not the same as street drugs used to get high.

Tips for Coping with Anxiety and Depression While in the Hospital
There is no single, simple way to adjust to a disability, but there are a few tips to keep in mind.

  • Follow a routine. Aside from the regular therapy schedule, try to go to bed the same time each night, and to set aside time for relaxing and visiting (either in person or on the phone).
  • Be open with staff, family and friends regarding your needs.
  • Ask questions about any aspect of your care that is unclear.
  • Share things that worry you with others. Keeping feelings bottled up often makes being in the hospital more difficult. Sometimes people have problems admitting anything bad has happened as a way to be protected from depression and anxiety. It is healthier to admit you may not be able to do everything you used to do.
  • Acknowledge that you will be sad about this for a while until you find new things to do that you enjoy. Try not to exaggerate these losses with thoughts such as “I can’t do anything anymore;” “I’ll never be able to find anything worthwhile to do again.”

Tips for Coping with Anxiety and Depression after Leaving the Hospital
Sometimes people have prejudices about physical disability that make them feel like “second class citizens” when they become disabled themselves. Sometimes people with a disability get into the habit of letting other people do things for them and as a result they start to feel helpless. Sometimes people with a disability start to avoid situations that make them nervous (for example going out in public where others can see that they look or act differently). This makes those situations much more scary or upsetting when they can no longer be avoided.

  • Set up a routine and stay with it to work on your recovery after leaving the hospital.
  • Stay involved in life. Find enjoyable activities – either ones from before or new ones.
  • Acknowledge improvements. This decreases the risk of boredom and depression and will boost self-confidence.
  • This is a stressful time, so be open to the support of others. Healthy relationships with family, friends or others with a disability can go a long way in preventing depression and anxiety.
  • There is also evidence that a strong spiritual life can help keep you healthier and hopeful.

Special Tips for Parents

Parents may need to provide more comfort and support than usual for their children. It is not unusual for a child to regress to an earlier stage of development following a traumatic event. Children may find it hard to separate from parents, become clingy or emotionally needy during a hospital stay. Children usually show signs of greater independence by the time of discharge. Please talk to your physician if these problems do not improve.

Additional Resources

American Medical Association (1998). Essential Guide to Depression. New York: Pocket Books.
Bourne, E.J. (2000). The Anxiety and Phobia Workbook. New Harbinger Press.
Mental Health: Does therapy work? Consumer Reports. November, 1995.
Sheffield, A. (1998). How You Can Survive When They’re Depressed. New York: Harmony.

Internet resources

For adults:
American Psychological Association:
National Institutes of Mental Health:
Psychology Information Online:

For children:
Kids Health:

Posted on BrainLine November 25, 2008

From the Rehabilitation Institute of Chicago, LIFE Center. Reprinted with permission.


How can they cause brain damage? I’m scared now bcs I recently was diagnosed with depression and have been taking pills

I was physically abused for 40 yrs. ... 2 marriages.... and my head generally took the brunt of the abuse. I was also in 2 car accidents. Again head injury. At this point someone special- a friend- spoke to another friend knowledgeable about TBI and told me he did. I began to realize after feeling hurt and betrayed that something was wrong. I go from happy to sad to panic like flipping a light switch. I get emotional and emotionally hurt over nothing. I don't want to go on this way I need some coping skills and ways to stop what's happening before I get worse.....

I have also suffered a recent brain injury (concussion). Medication is not an option for my panic and anxiety symptoms. I am now taking cranio- sacral therapy providing significant relief. How I recovered from my horrific addiction to phsyco meds 10 years ago is still a very painful memory not to be easily forgotten. I am convinced & am choosing a holistic safer route instead of the dead end road of pharmaceutical therapy. God Bless. Julie

Not to be disrespectful of the good work you are providing here, but please don't say that medications help with the relief of depression and anxiety. It simply is not a true statement. These drugs cause severe damage to the human brain, nervous system, organs and are neurotoxins. I was severely damaged by them and now have a form of TBI caused by these drugs. In the online forums I'm in we call this a chemical brain injury. Psych meds should never be used to treat mental health disorders. There are alternative holistic treatments out there. The statement made that meds are not addictive is incorrect. Please do in depth research outside of mainstream websites. Contact me if you need valid true information about medications. Please don't go down the rabbit hole of psych meds. Please. They will cause you severe harm as they did me.

I'm 12 years out from my TBI,and am here now reading for a recently injured friend. My heart goes out to you, those fighting through this darkness. I almost gave up. My healing really turned the corner for the better when I made exercise and slow flow, meditative yoga a daily priority. Please, please make movement a part of every single day! I'm only one voice, but research agrees: aerobic exercise reduces anxiety and depression. Group yoga was the hardest to join, but I believe it was the most beneficial. All good yoga teachers will offer modifications to help you practice safely and within any limitations. I also started daily morning walks and some gentle swimming. Sometimes I hated it, but i stuck to a routine, invited those closest to me to join sometimes, and fought to stay with it. I could feel I slept better. I now run or lap swim 5 days a week. Always. Its not about speed ( I'm super slow!) it's about brain oxigenation and cell renewal - essential for your brain's recovery, and your very soul's happiness. Yoga emphasizes rhythmic breathing, stretch, positive self acceptance, and quiet social interaction. At my lowest, I forced myself to go. Sometimes my husband even walked me in to class. We laugh about that now! No matter how low the day, I was always glad AFTERWARDS that I had gone. Believe, this will get better! Eat only healthful food, lots of fresh veggies, and add yoga and walking/running at any speed. Trust, no one is watching! I was afraid to look disabled in front of my neighbors. Really, most folks just didn't care... and now I know some are just like me: rooting for you every step of the way. There are more silent suffers of all kinds out there than we admit. My compassion for other humans grew because of the understanding this struggle forced upon me. Trust, with healthy living our brains do slowly heal. I may never be quite the same, but by golly I am plenty good enough. <3 I now run with a group too once or twice a week, and those folks have become the very best medicine I've ever encountered. Shared endorphins and sweat bring out the best in people - we were made for teamwork . Whether it's a walking group at the mall or a yoga class at the Y, please gift yourself the medicine of exercise. Namaste and love. You're going to make it past this. Lynn- TBI, 07/03/2002

along with the allopathic medicines i  think do any art of living programs specially (sudharshana kriya) and start  ayurveda u go further slowly reduce  and stop the allopathic medicines and fully take the ayurvedic medicines...regular do yoga ,pranayama,exercises and will get 100 percent results....

I've suffered from depression and been on medication to control it.  I gained weight and my kids said i no longer demonstrated emotions as a result of the medication.  I started taking meditation classes and it was very therapeutic. I highly recommend it to everyone.

I've been dealing with anxiety and major deprssion for a year and a half. I've tried several anti depressants and therapy. What do I do?

I've been battling depression and anxiety for over a year now wondering if it'll ever go away

Ive stuffed from depression and anixtety for many years and sometimes I find it hard to cope with it but I have a great family and they support me through it and I have counselling so that helps alot

As a 30+ year survivor (post severe-TBI) I can say that it does get better and more managable.
I have felt so down & out for so long ,how do I tell if it\"s depression or anxiety,or just that is the way life is .....There just seems to be no more enjoyable moments anymore in my life.....What gives ???

I agree with having a strong spiritual as well as emotional support can lift you over many hurdles that life has to offer. cure panic attacks

I find that having a strong spiritual faith can help immensly giving you hope for your future.

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