Why NFL Players May Be Prone to Depression as They Age
Junior Seau #55 of the Miami Dolphins tackles Tiki Barber of the New York Giants during their game at Giants Stadium in 2003. Photo by Al Bello/Getty Images.
All last weekend, there were a lot of “thwacking” noises coming from my living room, where the television set was tuned to the professional football playoffs. It’s that sound you hear when players collide on the field in the middle of a play and their helmets hit each other.
I had never paid much attention to it before. Like most fans, I’ve always accepted the “thwacking” and “whacking” as part of the game.
But this year’s playoff season has produced some new evidence that links head trauma with depression and suicide later in life — just the latest in a growing body of such evidence. So the sounds coming from my TV took on new meaning.
Just last week, the National Institutes of Health released a report on the brain of retired football player Junior Seau who shot himself to death last spring. The researchers found the former linebacker, who had been exposed to more than his fair share of hits to the head, had a degenerative brain disease when he committed suicide.
Now, this week, new research is being released that shows NFL players may be at higher risk of depression as they age due to brain damage from concussions.
Each year, about 1.6 to 3.8 million athletes suffer a concussion, according to the Centers for Disease Control and Prevention. While it’s been known that those concussions can lead to sudden changes in mood and thinking, the long-term effects have been less clear — especially when it comes to depression, according Nyaz Didehbani, lead author of a new report from the Center for BrainHealth at the University of Texas at Dallas.
And new evidence from that research could lead to medical interventions for retired players before their mental health deteriorates to the point of suicide, said Dr. John Hart, UT Dallas’ medical science director of the BrainHealth Institute for Athletes.
Dr. Hart and Didehbani joined me earlier this week to discuss what their findings mean for professional athletes, high-school students, and even peewee football players. Read our conversation below.
BETTY ANN BOWSER: First of all, thank you both for being with us. There’s a building national discussion about how concussions may impact athletes in the long-run. Tell us how your research fits in.
DR. JOHN HART: As a neurologist, even going back into the ’90s, I started seeing patients who were having difficulty, not just in football, but in a number of sports after concussions. It affected their thinking, and at times, also their mood. The pattern seemed to be that when I looked at these folks, they looked different than other individuals who were developing problems because of aging. So I started a study, with the focus on patients who are alive, who had a history of concussion, and then conducting tests to assess their neurological functions and their cognitive and thinking abilities.
BETTY ANN BOWSER: And what were you looking for?
DR. JOHN HART: We wanted to see how best we could find who had a problem with cognition and mood, and to see if those people who had problems had anything on their brain imaging that could serve as a marker. What we found is that in NFL players, greater than half of those we studied didn’t have a problem. The ones who did have problems were experiencing problems in mood — with depression being the mood problem seen most — or in cognition, where the problem was either finding words or remembering things like names, appointments and phone numbers. When you looked at their brain scans, those players often had abnormalities in their white matter.
BETTY ANN BOWSER: White matter?
DR. JOHN HART: That’s the matter that carries signals to cells in different parts of the brain, and it can be damaged in times of head injury and concussion. In our study, we found that in the group of players that had problems compared to those who didn’t — all of whom had concussions — the white matter was damaged in the ones with symptoms. So that’s an important marker for us. When you look at people who actually have symptoms, there is something that looks abnormal in their brain and it’s the connection between areas. When we looked at the NFL players who had abnormal connections, we also saw that in the areas where those connections are supposed to be — the areas for word finding and memory and thinking — the blood flow to the brain cells they’re connecting was abnormal.
BETTY ANN BOWSER: And what’s the implication for that?
DR. JOHN HART: It suggests that this is an active thing going on. When these guys are developing problems, it’s not just an old injury that’s aging. Something is actively happening in their brain that is associated with problems. And for those players that had problems, we were then able to find them treatments that could either help reverse those problems in terms of the depression and slow down cognitive decline.
BETTY ANN BOWSER: It’s been known that repeated concussions can lead to suicide. Just last week, the National Institutes of Health announced that after looking at the brain tissue of Junior Seau, researchers had determined he had Chronic Traumatic Encephalopathy — or CTE — a neurodegenerative condition that can lead to memory loss, dementia and depression. Unfortunately, the only way you can look at whether someone had CTE is postmortem, during the autopsy. So could your research advance our ability to help these athletes while their alive.
DR. JOHN HART: Yes, the key difference in our research that we’re looking at live people. I think we need to put a real focus on guys that are alive so that we can figure out whether we prevent these problems. So we’re attempting to link together a number of things: Do you have symptoms, what are the problems, what’s the history and what imaging goes with these factors? And if people have problems, we can then treat them. While CTE is out there in the press a lot because of autopsies of people who committed suicide, I’d like to focus the discussion on: What are people like while they’re alive — what symptoms do they have that we can find early to detect and prevent or treat?
BETTY ANN BOWSER: The point that you’re making is that if these guys could be caught earlier, when they’re in the depression stage, perhaps some of these suicides could be prevented.
DR. JOHN HART: Absolutely. People have been suicidal, we have treated them, and we have treated their depression so successfully that they’re back to feeling normal. And often, these symptoms are not evident to the patient. So if you don’t ask them about things like mood, energy level, sleep, weight, negative thoughts, guilty feelings, their ability to initiate things or make decisions, we’re not going to find out. Concussion-associated depressions are often less about mood and crying but have a lot of the other symptoms that still could lead to suicide and death but are treatable and preventable.
BETTY ANN BOWSER: A number of years ago, I covered some research at the University of Pittsburgh that led to a test used by athletic trainers. It’s pretty simple — when a child or young person has a concussion playing soccer or football, whether it’s a boy or a girl, they have to rest.
DR. JOHN HART: Yes, and guidelines were developed that said that when someone has a head injury in a game that causes any kind of symptom – dizziness, balance problems, confusion, headaches or anything else that changes their ability to think clearly — they are to be stopped from playing any longer that day or in that game. They should sit and rest physically and mentally until all their symptoms have gone away, and once all their symptoms have cleared, then they can do exercise just to see if exercise brings back the symptoms. If the exercise does bring back the symptoms, they should go back to mentally and physically resting. Those are the standard guidelines that have been adopted by the NFL, NCAA and high school athletics around the country. And in that past, that didn’t happen with most of the guys we’re studying now. As soon as they were clear enough, or even not, they went back to the game. So that set them up for second concussion syndrome, where the second hit causes more damage if you haven’t let the brain heal.
BETTY ANN BOWSER: Is this really happening in the NFL, where there’s such a tough-guy culture and there’s so much professional and financial pressure?
DR. JOHN HART: I think we’ve made great strides this year. They’ve been sitting guys out – some of them for weeks. I think you’re seeing more and more of this because of the publicity, because of the attention, that if you sit and rest, you’re helping your team a lot more than if you go in and you’re not right. And the same thing is happening in the military. We have two large studies here on Post-Traumatic Stress Disorder, and the generals and the colonels are saying, “When you get a head injury, sit out until you get better. You’re helping squad and your unit.”
BETTY ANN BOWSER: What is the message in all of this research for parents who have children who play contact sports?
DR. JOHN HART: My son plays contact sports. With the present guidelines — and if we make sure that people follow them — I don’t have a problem. And if an athlete starts having difficulties, they should get things evaluated by a medical professional. We also need to keep doing our work scientifically to improve the research and make the guidelines even better.
BETTY ANN BOWSER: Can you see a day coming in the NFL when if a player has repeated concussions, their career could be over in the same way as if they had an injury to another part of the body?
DR. JOHN HART: I can see that point, yes. And that’s the one thing we have to do on the science end, is get better at the question of how many concussions is too many? That piece of information isn’t clear yet but it’s essential to get to.
This conversation has been lightly edited for length.