Jockeys Learn Concussions Can Impact Mood

At one point during a discussion about concussions at the Jockeys' Guild assembly Dec. 13 in Las Vegas, Dr. Dan Han paused and told a rider his treatment may have been a bit different just three years ago because research in concussions and head injuries is continually updated.

While Han conceded that treatment ideas will likely continue to change, he presented the most up to date information on concussions to riders to let them make informed decisions should they suffer a concussion. He said it's important for riders to follow concussion protocols that encourage a gradual return to activity. He emphasized that they communicate with a physician about symptoms, including mood changes, anxiety, and depression following an injury.

While in recent years the Guild has offered many sessions on the dangers of concussions—suffering a second concussion before the first is fully healed is especially dangerous—Han's presentation Tuesday focused on how concussions can affect mood. The goal was to help riders assess if a concussion could be a cause of depression or anxiety—or reduced emotions for that matter.

Han, the chief of neuropsychology clinical service at the University of Kentucky, noted that such determinations linking concussion and mood can be tricky but he noted the bottom line is people react differently than they would have before the concussion.

He said on a scale of 1 to 10 in terms of 10 being most upset, he would probably rate an '8' on the day his dog died. He noted that such situations are not depression but normal emotional reactions to an event that has occurred.

"If I'm feeling 10 and the situation requires 10, that's not disease, that's healthy brain function," Han said. "But when trauma occurs, when the mechanism gets hit because of a fall or because of a sustained traumatic event toward the head, then that '8' may turn into a '4.' Or a '2' may turn into '6,' and so on."

"Oftentimes when we see someone whose had a concussion have mood issues, it's the mechanism that's bruised. These things do get back to normal with time, like any other injury."

Han said it's important to talk with a physician because there can be some amount of anxiety and depression because of the circumstances of the injury—missed time from sport, axiety about money issues while being out of work. He said such normal emotions and concerns shouldn't be confused with a person's mood being altered because the injury is affecting brain function. The key is if the depression or anxiety is out of line with any life events going on.

Han said sometimes concussions and brain injuries can dramatically affect a person's mood or personality. He told a story of a patient who in the months after an injury completely changed: lost her job, lost her marriage and became distant from friends and family. Han said he talked with family and friends who said before the fall she had a completely different personality. 

"Then eight months later, she came back to normal," Han said. "She would come in for her follow-up visits and say, 'Dr. Han, my life completely changed. I don't know what to do or how to pick up the pieces.' These things do happen."

While the message could be of concern, Han noted that he participates in Brazilian jiu jitsu and, "gets knocked out all the time." He said his interest is to not keep athletes away from their activity but to help them stay in top shape and help them safely return to their sport following and injury. 

He did say friends and family can help keep an eye on a person who has suffered a concussion to note any changes in mood not in line with associated life events.

"The take home message from me is that I really wanted to introduce you to the whole new concept of understanding how mood and depression and anxiety work. When a healthy brain is depressed because something depressing happened; if a healthy brain is making you feel anxious because something anxiety-provoking happened; that's perfectly healthy," Han said. "You may be in a lousy situation but you don't have to worry about your physical mechanism.

"That's up for question when that physical mechanism is hit. If you're speeding and you get a ticket and the car was working fine, then, 'yeah, it was your fault.' But if your accelerator and gear box is completely broke because someone T-boned you, and now you can't stop the car, that's not you that's the car.

"The same thing applies to mood, depression, anxiety in context to head injury. Hopefully that will guide you in making an informed decision for your return."