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 Article of Interest - Depression

Recurrent concussions may be linked to depression, North Carolina study finds
by Lauran Neergaard, Canadian Press and AP, May 5, 2003
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Retired football players who suffered three or four concussions have twice the risk of later developing clinical depression - a risk that rises with even more injuries, new research says.

It's the latest finding that suggests what many people consider merely a bang really can have long-term repercussions. Now scientists are beginning intensive imaging studies to pin down just what happens inside the brain when someone suffers a concussion.

It's not a concern only for professional athletes. Concussions, a mild brain injury, can be caused by any hard blow or jolt to the head - from whiplash during a car accident to a tumble onto a sidewalk. An estimated 1.1 million Americans suffer a concussion each year.

But athletes, both professional and amateur, are more likely than the average person to suffer repeated concussions.

That's a particular problem because concussions can be hard to diagnose - and if you get banged around again before you've fully healed and you can suffer potentially deadly brain swelling. Still, specialists say athletes often beg to get back in the game, swearing they're fine.

"I always say, 'You can ice your ankle but you can't ice your brain,' " says Dr. Julian Bailes of West Virginia University's School of Medicine. "You don't send a player who's still symptomatic back to play."

Most people fully recover from a concussion. But a fraction suffer lingering, sometimes severe, problems with memory and other functions - and doctors wonder if sufferers of bad or repeated concussions are more prone to neurologic disease later in life.

As a first step in studying that question, Bailes and colleagues from the University of North Carolina's Center for the Study of Retired Athletes analyzed data from almost 2,500 retired National Football League players.

Bailes found no link between concussions and later Alzheimer's disease or strokes, two common worries.

But 263 of the retired players suffered depression. Having three or four concussions meant twice the risk of depression as never-concussed players - and five or more concussions meant a nearly threefold risk.

The study, presented last week at an American Association of Neurological Surgeons meeting, supports earlier research that linked concussions suffered by Second World War soldiers to depression decades later.

For better proof, University of Pittsburgh neuropsychologist Mark Lovell now is tracking how NFL and National Hockey League players fare in the years after a concussion.

More intriguing, he's using advanced MRI scanners to image the brains of high school athletes in a study that will rescan up to 250 of them who go on to suffer a concussion - providing before-and-after shots that could finally show just what the injury does to delicate brain tissue.

Scientists already know a concussion somehow throws crucial brain-chemical reactions out of whack, but they're not sure for how long - key to deciding when the patient is healed - or if that imbalance could cause a chain reaction leading to later problems like depression.

For now, Lovell and other specialists want athletes and their coaches and relatives to start taking concussions more seriously.

"If you get hit and have a headache, don't do the macho routine - you need tell somebody," Lovell says.

Look hard for symptoms - they're not always obvious in an adrenaline-pumped athlete. Loss of consciousness, from a few seconds to a half-hour, is the best-known symptom but doesn't always occur. Other symptoms include confusion, persistent headache, cognitive problems, fatigue and changes in mood, vision or hearing.

Particularly crucial is short-term memory: How long before you were hit can you remember? The longer the period of amnesia, the worse the concussion.

Watch for changes in behaviour, signs that signal pain the patient denies.

Coaches have long thought that if obvious symptoms disappear within 15 minutes, it's safe to put a player back in the game. But last winter, Lovell discovered that teenage athletes with the mildest of concussions often have subtle memory and other symptoms days later - refuting that advice.

Rest is the only way to heal, and Lovell's research suggests that takes about a week.

How many concussions is too many? Each one suffered seems to render someone more vulnerable to another, but "there's no magic number that we know at this point in time where you can say, 'OK, you've now had that final one concussion too many,"' Lovell says.

Concussions can have varied symptoms that last for days or weeks, but that don't always arise immediately.

Doctors suspect a concussion if, after a blow to the head, someone loses consciousness, can't remember the time around the injury, or is confused or disoriented.

Other symptoms include persistent headaches; trouble concentrating or making decisions; slowness in thinking, acting, speaking or reading; getting lost or easily confused; fatigue; blurred vision; changes in mood or sense of taste or smell.

The government offers the following tips for healing:

-Get plenty of rest.

-Avoid activities that could lead to another head injury, such as sports, until your doctor clears them.

-Ask your doctor when it's safe to drive a car, ride a bike or operate heavy machinery, because your reaction time may be impaired after a concussion.

To avoid a concussion:

-Always wear a seat belt and buckle your child into an appropriate safety seat.

-Wear a helmet whenever riding a bike, motorcycle, snowmobile or all-terrain vehicle.

-Wear a helmet during such sports as football, hockey, boxing, horseback riding, skiing; and when in-line skating or skateboarding.

-Make sure your child's playground has a shock-absorbing surface such as mulch or sand.

-Take steps to avoid falls, such as installing stair rails and nonslip bath mats and using stair gates when young children are around.
  

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