Brain scars from combat injuries in veterans linked to depression

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Family members and friends of veterans have long known that not all the wounds of war are visible. But doctors have never fully understood how, exactly, returning combat veterans experience severe depression and mood imbalance.

While the emotional trauma of seeing death and destruction has been widely discussed, there’s more evidence that many soldiers’ mental health issues have a strong physical component as well. Researchers at Walter Reed National Military Medical Center found that Traumatic Brain Injury (TBI)—physical damage done to the brain from violent outside forces—disrupts the circuitry of the brain’s cognitive-emotional pathways.

This might be the root cause of depression symptoms, and provide more insight into possible treatment. The researchers presented their findings yesterday at the annual meeting of the Radiological Society of North America (RSNA).

While Post Traumatic Stress Disorder (PTSD)—the severe psychological shock that persists in a veteran’s brain after violent experiences—is well known amongst the larger public, TBI—equally as damaging and perhaps more insidious—is not so much. So far, 352,619 soldiers worldwide have been diagnosed with TBI since 2000, according to the Defense and Veterans Brain Injury Center, and many struggle with chronic anxiety, mood problems and depression.

“Sometimes you find yourself saying, ‘I wish…I would have lost a body part,’ so people will see—so they’ll get it.”

The symptoms of each are similar, but TBI is a physical injury that’s caused by violent shockwaves to the brain, whereas PTSD is a psychological affliction. It happens to soldiers near explosions or who get hit in the head by debris—it also is prevalent in retired NFL players from constant blows to the head.

Yet all the unknown variables have made it difficult to treat TBI. “Sometimes you find yourself saying, ‘I wish…I would have lost a body part,’ so people will see—so they’ll get it.” Army First Sgt. David Griego told National Geographic. Griego is a veteran of tours in both Iraq and Afghanistan.

Researchers at the National Intrepid Center of Excellence at Walter Reed used two different MRI (brain imaging) techniques on 130 active service members diagnosed with mild TBI, and on a control group of 52 men without TBI. What they found was that the circuitry connecting important regions of the brain for cognitive and emotional control—known as white matter tracts—was disrupted in soldiers with mild to severe depression symptoms.

“We can link these connectivity changes in the brain to poor top-down emotional processing and greater maladaptive rumination, or worrying, in symptomatic depressed soldiers after mTBI,” physicist Ping-Hong Yeh of Walter Reed said in a public statement.

Yeh thinks that these new findings might lend themselves to personalized medical treatments in the future. We’re going to need it. “This is an ongoing problem facing a large number of warriors in current areas of conflict, and it is likely to be a persistent problem for the foreseeable future,” he said.