Study Identifies Brain Injury Patterns Associated With Anxiety, Depression

Individuals with depression and anxiety related to concussions show distinct injury patterns in the brains, according to the authors of a new MRI study, who say this finding may lead to better treatment and understanding of these disorders.

Researchers from the University of Pittsburgh Medical Center (UPMC) used diffusion tensor imaging (DTI)—an MRI technique that measures the integrity of white matter—to determine if nerve injuries are at the root of symptoms of post-traumatic depression and anxiety. The team acquired DTI and neurocognitive test results for 45 post-concussion patients. Among these participants, 38 displayed irritability, 32 experienced depression, and 18 demonstrated anxiety. The investigators compared the results with those of 29 post-concussion patients with no neuropsychiatric symptoms.
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The authors saw unique white matter injury patterns in the patients with depression or anxiety, with the depression patients showing decreased fractional anisotropy (FA)—a measure of the structural integrity of white matter connections—in comparison to the control group. Anxiety patients had diminished FA in the vermis, a part of the brain responsible for helping to modulate fear-related behaviors, according to the authors, who note that the vermis has not been linked to dysfunction in non-traumatic anxiety disorders. As such, they say the findings may demonstrate that different treatment targets are needed for patients experiencing anxiety after undergoing trauma.

Primary care practitioners should be aware that depression and anxiety after concussion do have underlying organic brain injury, and are not necessarily just a result of the stressors and frustration that may accompany traumatic brain injury,” says Lea M. Alhilali, MD, an assistant professor of radiology at UPMC, and lead author of the study. “These symptoms may be a sign of an underlying white matter injury and should be treated appropriately.”

Finding similar abnormalities between patients with depression after concussion and major depressive disorder may indicate that post-traumatic depression has more in common with depression in the general population than previously thought, adds Alhilali, which she says suggests treatments that are effective for major depressive disorder may be effective in post-traumatic depression as well.

On the flip side, however, “finding a different injury pattern in patients with post-traumatic anxiety than the abnormalities seen in anxiety in the general population may indicate that traditional treatment methods for non-traumatic anxiety may not be as effective in patients with anxiety after concussion,” concludes Alhilali.

—Mark McGraw


Ahlilali L, Delic J, et al. Evaluation of White Matter Injury Patterns Underlying Neuropsychiatric Symptoms after Mild Traumatic Brain Injury. Radiology. 2015.