Toronto psychiatrist Dr. Shree Bhalerao specializes in traumatic brain injury.
sees numerous patients experiencing serious emotional problems months, and sometimes years, after a head trauma.
Too often public discussions around concussions focus on the physical fallout, he
said - headache, dizziness, nausea and other post-concussive symptoms.
Missing is the "psychiatric sequelae" of brain injury.
Think of a snow globe, Bhalerao
says: "You can shake the globe, but all the parts don't settle in the same way."
says people who suffer a head injury often experience disturbed sleep, impaired thinking, anxiety and depression.
Their minds can feel thick with fog.
In extreme but rare cases people can experience paranoia and other symptoms of psychosis.
"They not only are trying to deal with the pain they've suffered physically, but the emotional pain," Bhalerao
That can lead people toward abusing alcohol, prescription pain medications or self-medicating with illicit drugs, "which again can affect their thinking, sleep and mood," he
In a public service YouTube video, called the After the Hit Program, Bhalerao
, who plays and coaches recreational hockey, describes how professional players can reach speeds of 30 to 40 kilometres an hour on the ice.
With a blow to the head, the brain is shaken in the skull, triggering an inflammatory response that can damage or irreversibly destroy brain cells.
Most sensitive is the frontal lobe, the part of the brain that's responsible for memory, emotion, reasoning, judgment and empathy.
People who have suffered a head injury can lose the ability to control their emotions.
In essence, "the brakes are gone," says Bhalerao, an associate professor at the University of Toronto and department of psychiatry at St. Michael's Hospital.
Other parts of the brain that secrete neurotransmitters related to depression and anxiety are also extraordinarily sensitive to any kind of physical injury, he
But doctors rarely ask about head injuries in patients with symptoms of depression, Bhalerao
"With depression comes suicide.
It's not something you can ignore," he