BLOG: Concussions, depression and the eyes – it’s all connected
by Michael A. Longyear, DC, DACNB, CCSP
It has long been known that concussions cause physical symptoms such as headaches and nausea. But the untimely deaths by suicide of two former NFL football players in 2011 (Dave Duerson) and 2012 (Junior Seau) focused more attention on the connection between head trauma and mental health. After their deaths, both men’s brains were examined by researchers and were found to have chronic traumatic encephalopathy, which likely contributed to them taking their own lives.
These are extreme cases, both regarding the degree of head trauma and the suicidal level of depression. However, they do highlight the important connection between concussion and neuropsychological problems at the less severe end of the spectrum. Not only do concussion-related symptoms contribute to depression and anxiety, but pre-existing depression and anxiety are also risk factors for more prolonged recovery from concussion.
Interestingly, on video nystagmography, eye movements are similarly disordered in patients with concussions or other brain injury and in patients with depression, anxiety and bipolar disorder. In particular, saccadic latency is longer, and saccadic accuracy is lower in all of these conditions.
The connection to eye movements is not surprising. Eye movements provide us with key insights into brain health. Poor saccades, pursuits or fixation are indicative of problems with brain function. Moreover, given that the same areas of the brain that make eye and body movements smooth and coordinated also help to balance and smooth out thoughts and emotions. It’s not surprising that concussions and mental health conditions can produce similar eye movement problems.
The good news is that treating either area can have positive effects all around. Working on balance and eye movements with vision therapy or visual training for the concussion symptoms can also help to balance out the emotional state. This isn’t to say that vision therapy can fix major mental health problems on its own. In fact, receiving treatments like neuro emotional technique, eye movement desensitization and reprocessing or talk therapy for the mental health disorder is likely to make other types of therapy progress faster and shorten the length of post-concussion syndrome.
Concussion care should more frequently include discussion of neuropsychological symptoms. Because mental health is often considered taboo, researchers and clinicians sometimes don’t ask about depression or stress — and patients may not bring it up in a concussion care setting either.
Optometrists are in a unique position to see from the eyes what might be going on with the whole person and perhaps refer the individual for further mental health and/or concussion care. If you see a breakdown in eye movements, such as disordered saccades, that is a strong sign of a breakdown in brain function. I encourage a few follow-up questions: “Have you had a concussion or any head trauma? How are things going for you?” These questions might feel awkward at first, but it’s worth getting past the awkwardness. You may be the first person to ask, and the first person a patient opens up to about feeling sad or depressed.
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Michael A. Longyear, DC, DACNB, CCSP, is a diplomate of the American Chiropractic Neurology Board. He is director of applied clinical neuroscience at the NeuroLife Institute in Marietta, Ga., where he works with athletes and concussion patients. Longyear also serves as director of applied clinical neuroscience at the Brain Optimization Institute and Integrative Health and Allergy Center in Jacksonville, Fla., a noninvasive neurorehabilitation center where patients are treated for a wide range of neurological issues without drugs or surgery.
Disclosure: Longyear reports no relevant financial disclosures.
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