Shane Diel is still recovering from a severe head injury he suffered in a car crash three years ago.
"I'm sore, I'm tired a lot, probably more depressed than I was, but that's all getting better though," he said.
His depression is not uncommon.
"Fifty-three percent of the individuals we studied had at least one depressive episode during the year following traumatic brain injury," said Dr. Charles Bombardier of the University of Washington.
"About half of the individuals who experienced major depression did so in the first three months following their injury," said Dr. Jesse R. Fann of the University of Washington
Dr. Bombardier and Dr. Fann followed 559 hospitalized traumatic brain injury patients at Harborview Medical Center for one year.
"Even among those with no history of major depression prior to their injury, 41 percent experienced an episode of depression in the year following their injury," said Dr. Fann.
"People who were depressed after brain injury were nine times more likely to experience significant anxiety problems compared to those who were not depressed," said Dr. Bombardier.
At the same time, less than half of these patients ever get treated for their depression.
"We found that only 44 percent of the people who had been depressed received any kind of treatment, only about 40 percent received anti-depressants and only 20 percent received psychotherapy," said Dr. Bombardier.
Shane says therapy helps him focus on the positive, thinking about his children and someday getting back to work.
"It was very important. It was very good because it gave me ways to think about other stuff than all my problems so it was very helpful," he said.
"There is a real opportunity to integrate mental health care in a systematic way into the standard care of individuals with traumatic brain injury and potentially improve their clinical outcomes," said Dr. Fann.
Researchers also found that women, people with alcohol dependence and those between ages 30 and 44 were at higher risk for developing depression after a brain injury.
The study appears in this week's Journal of the American Medical Association.