Concussions and depression:

December 6 <:article>

Cynthia Kamzelski heard the recent news reports out of Ohio — a young athlete, apparently taking his own life after struggling with the effects of concussions — and everything raced back.

“I’ve been just sick about it,” she said.

Kamzelski’s son, Kaelin, was a sophomore in high school when a hit on the football field rattled his head. In the months that followed, Kaelin experienced mood swings and temper tantrums, and his grades plummeted. In the hallways at school, he was harassed and teased for not returning to the team quickly enough — so badly that Cynthia pulled him out of classes and he finished the school year via online coursework.

Counselors and neurologists didn’t have answers. He’s just being a teenager, they told the Kamzelskis.

When the family finally connected with a specialist in Pittsburgh, about 30 minutes from their home in Baden, Pa., Micky Collins asked Kamzelski during that initial visit: Do you experience any depression or suicidal thoughts?

 

Yes, Kaelin said.

“This is all from your concussion,” Collins told him.

Collins sees young athletes such as Kamzelski walk through the doors of the Sports Medicine Concussion Program at the University of Pittsburgh Medical Center nearly every day. While research and headlines often focus on the long-term effects of concussions, doctors say the days, weeks and months that immediately follow a traumatic brain injury can be crippling, particularly for young people.

In Ohio this week, a family buried its son, a 22-year-old wrestler and walk-on football player at Ohio State. Shortly before authorities say Kosta Karageorge turned a gun on himself, he sent a text message to his mother: “I am sorry if I am an embarrassment but these concussions have my head all [expletive] up.”

Sophia Karageorge told the Columbus Dispatch that her brother was “not himself.”

“Every time he’s had a concussion, he’s been evaluated and listened to his trainers,” she said. “He’s been properly taken care of by OSU the entire time he’s been an athlete for them. But . . . his repercussions from [concussions] have been long term or delayed after the fact.”

While most consider concussion research still to be in its nascent stages, the science increasingly points to a strong link between head injuries and psychiatric and mood disorders.

 

Jeffrey Max is a psychiatrist at the University of California-San Diego who specializes in traumatic brain injuries in children and adolescents. He studied a group of children ages 5 to 14 for several months following a reported concussion.

“It was really quite alarming,” he said of the results.

In the first six months, 36 percent — 25 of 70 children — experienced a new onset of psychiatric disorders. Ten percent experienced full depressive disorder. When Max followed up at the 12-month mark, the overall number had fallen, but 28 percent of the children were still experiencing a psychiatric disorder.

He says more serious brain trauma only exacerbates matters. After a severe head injury, the rate of onset of new psychiatric disorders in children is 50 to 60 percent. For comparison, the rate a year following an orthopedic injury — a leg fracture or knee sprain, for example — is 10 percent. “Astounding,” Max puts it.

Coincidence or causation?

Kaelin Kamzelski suffered his decisive concussion early during his sophomore season, when he was just 16. It was his second in three years.

Some researchers believe repeated head injuries can wreak even more psychological damage. One study, published in the Journal of Adolescent Health earlier this year, found repeatedly concussed teens to be three times more likely to develop depression.

That study was authored by Sara Chrisman, a pediatrician at Seattle Children’s Hospital, and relied on data from the 2007-08 National Survey of Children’s Health, which included health information from more than 36,000 adolescents. While there is a relationship between head injuries and mental and mood disorders, Chrisman said further research is necessary to establish causation.

“Depression is defined by symptoms, and concussion is defined by symptoms,” she explained. “Many symptoms overlap.”

Chrisman said it’s theoretically possible that the higher rates of depression among teens who have experienced concussions could be a result from the actual injury itself but that it also could stem from doctors mistaking symptoms, the impact and stigmatization from the recovery process or a number of other factors.

Most doctors were slow to draw a line between Kamzelski’s hit on the football field and the lingering struggles he had in the months that followed. Kamzelski became only more frustrated and despondent as time passed — the “rabbit hole,” as Collins calls it. He sat in his room alone, drove his mother’s car aimlessly, told friends they would never see him again and replayed the same thoughts over and over. Therapists and medications had little effect.

“Just dark thoughts,” he said. “It wasn’t me. It was like my mind was telling me to do something, that nobody would care if I was gone.”

Brian Roberts, a 14-year major-league baseball player, suffered concussions in 2010 and ’11 and was limited to just 56 total games during the 2011 and ’12 seasons as he struggled with recovery.

“It can take you to really dark places,” said the longtime Orioles second baseman, who retired in October. “For me, that was eight, 10 long months. I’ve been following this Ohio State thing — I’d be lying if I said I didn’t have some of those terrible thoughts and feelings. It was unbearable.

“There were times where my wife, frankly, was worried about leaving me at home by myself. It’s a scary thing.”

A dangerous age

Even without head trauma, psychiatric and mood disorders begin spiking as young people enter college. Brian Hainline took over last year as the NCAA’s chief medical officer. He made concussions his first order of business; addressing mental health was his second.

He oversees a population of young people who are particularly vulnerable. Disorders and conditions such as schizophrenia, bipolar disorder, depression and anxiety see peaks among college-aged people. Hainline explained in a recent interview that this age group is experiencing “intense neurobiological development in the frontal lobe of the brain.”

“You couple that area of brain vulnerability with going into an environment that existentially is very different,” he said. “Many for the first time, they’re away from their parents. First time they’re in a new environment where there’s a whole different kind of peer pressure. First time they’re maybe exposed to alcohol, drugs or other risk-taking behaviors. . . . When you add all these things in a still-maturing brain, different things can happen.”

A recent paper by the NCAA examined data from eight National College Health Assessment surveys from 2008 to 2012 and found that student-athletes experienced depression at slightly lower rates than non-athletes: among males, 21 percent compared with 27 percent of the general population, and among females, 28 percent of athletes compared with 33 percent.

The same NCAA report pointed out there are relatively few cases of suicide by active college athletes and noted that “student-athletes appear to be less likely to have suicide ideation and to make suicide attempts than other college students.”

“Although depression is more common in professional football players who have suffered with multiple concussions, there is no clear relationship that has been described in collegiate football players,” read one chapter focused on suicide. “Suicide has occurred in professional football players who developed CTE, but the causal relationship between CTE and concussion is unknown, and the relationship — if any — of suicide and CTE is also unknown.”

Examining the ‘chessboard’

Collins helped open UPMC’s Sports Medicine Concussion Program in 2000 and today serves as its executive director. More than 20,000 patients visit the clinic each year, from 5-year-old soccer players to professional athletes such as NASCAR driver Dale Earnhardt Jr. and baseball players Brandon Belt, David Ross and Roberts.

After a slow start, concussion awareness has steadily grown, and business picked up for Collins accordingly. But while he and his staff had made huge strides in diagnosing and assessing head injuries, Collins was still troubled by the way patients felt as they left the clinic.

“I was saying to myself, ‘I’m getting sick and tired of all these kids with problems and we don’t having anything we can do to treat it,’ ” he said. “It felt like I was banging my head against the wall.”

So Collins shifted gears, focusing his efforts on treatment and rehabilitation. He has identified six trajectories for a concussion injury, and because everyone experiences the injury differently, each response plan also must be unique.

“We call that the chessboard,” he said. “You have to figure out the chessboard before you can figure out an individualized plan.”

Kamzelski had missed the end of his sophomore season and the entirety of his junior season by the time Collins promised to cure him. Kamzelski’s treatment focused on rehabbing two areas impacted by the concussion: his eyes and vestibular system. Sometimes twice a week, he made the half-hour drive to Pittsburgh and went through a series of exercises that were aimed at challenging and reconditioning his brain.

Slowly, the headaches became less frequent. His mood seemed more stable. Clouds lifted. Last fall, after nine months of treatment, he returned to the football field and played most of his senior season as the starting center at Ambridge (Pa.) High.

“Dr. Collins saved my son’s life,” Cynthia Kamzelski says today. “I’m not even kidding. We were living a nightmare.”

Kaelin, now 18, said he hasn’t experienced any symptoms from his concussion in more than a year. He’s in his first year at a Pennsylvania community college, where he’s studying to become a nurse.

“I look back,” Kaelin says, “and I know that guy wasn’t me. I don’t know how I could ever think that way or say the things I did.

“That person wasn’t me in any way, shape or form.”

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