How pain, anxiety, depression, and PTSD can affect memory
How hurting, worry, low mood and trauma stress crowd out memory, and what helps
Imagine a 41 year old driver three months after she was rear ended at a stoplight. Her neck still aches by midafternoon. She tenses at every set of brake lights, sleeps poorly, and walks into the kitchen with no idea why she went there. She wonders whether the concussion has damaged her memory for good.
That picture is common. The CDC lists memory and concentration problems as concussion symptoms, along with anxiety and sadness. Most people start feeling better within about two weeks [1]. When thinking problems drag on for months, pain, worry, low mood and trauma stress are often part of what keeps them going.
This article looks at how those four conditions affect attention and memory, how they are checked, and which treatments have good evidence. Looking at them does not cast doubt on your brain injury. Both can be present at the same time. Several of the pieces respond well to treatment.
How often these problems follow a crash or concussion
Some of the best numbers come from a large U.S. research project funded by the National Institutes of Health. It followed 1,155 adults with mild traumatic brain injury (TBI) treated in emergency departments at 11 major trauma centers [2]. The researchers compared them with 230 people who had broken bones or other injuries but no head injury [2].
At three months, 20% of the brain injury group reported symptoms that pointed to PTSD (posttraumatic stress disorder), major depression or both. That compared with 8.7% of the comparison group [2, 3]. At six months the figures were 21.2% and 12.1% [2, 3]. The researchers said doctors may need to watch patients’ mental health for many months after the injury [3].
Some groups in the study were more likely to have problems. Less schooling, a past mental health condition and identifying as Black were each tied to higher risk [2, 3]. Being hurt in an assault raised the risk of PTSD, though it did not raise the risk of depression [2, 3]. These are patterns across large groups. They say nothing certain about your own outcome.
Depression is also common across all levels of brain injury. The TBI Model Systems are a federally funded network of brain injury research centers. Their factsheet puts the share of people with TBI who qualify for a diagnosis of major depression, or a milder depression that lasts a long time, at roughly 27% [4]. Compared with the general public, people who have had a TBI are close to eight times as likely to have major depression [4].
Pain is easy to overlook
Pain is even more common. A pooled analysis described in a 2017 review found chronic pain in 75.3% of people with mild TBI, compared with 32.1% of people with moderate or severe TBI [5]. The authors called pain a relatively neglected problem after mild brain injury [5].
Headache leads the list. The VA/DoD guideline on mild TBI dates from 2021 and was written for veterans and service members. It says headaches after injury affect 25% to 78% of people. They show up more often after mild injury than after more severe injury [6]. Many look like tension headaches or migraines [6]. A crash can also hurt the neck, back or shoulders. Other parts of the body are often injured in the same event as the brain [7].
Why pain and distress compete with memory
To remember something, you first have to notice it and hold it in mind long enough to store it. That first step depends on attention. Attention has limits. When something else is pulling hard on it, less is left over for the conversation in front of you or the grocery list in your head.
Pain pulls hard on attention. The 2017 review describes how pain demands attention and leaves fewer mental resources for other tasks [5]. A TBI Model Systems factsheet puts it simply: pain can make it hard to stay focused, remember things or think through complex ideas [7].
Depression works in a different way. Trouble concentrating is one of its standard symptoms, along with low energy and changes in sleep or appetite [4]. When everything feels heavy, the effort needed to take in new information is harder to find.
Anxiety tends to show up in busy, rushed or crowded settings. People with TBI may feel overwhelmed when a situation calls for lots of attention or fast thinking [8]. Forgetting things can itself set off worry, which then makes the next task harder [8]. A TBI Model Systems guide describes worries and headaches as distractions from within, much like noise in a room [9].
PTSD shares many symptoms with brain injury. The National Center for PTSD lists memory problems, trouble staying focused, quick anger and poor sleep among symptoms that can come from a TBI and also from PTSD [10]. It also notes that many people who have a TBI go on to develop PTSD [10].
Sleep problems run through all of this. Most people with TBI who live with chronic pain report some kind of sleep problem [7], and poor sleep can bring on low mood and mood swings [11].
Comparison compiled by Safety Behind the Wheel Foundation
How each condition can get in the way of remembering
| Condition | How it can show up | Effect on attention and memory | Approaches with support |
|---|---|---|---|
| Pain and headache | Headache, neck or back pain, worse with effort | Pulls attention away, so details slip | Pain psychology, exercise, pacing |
| Depression | Low mood, low energy, sleep or appetite changes | Trouble concentrating | Counseling, medicine or both; exercise |
| Anxiety | Racing heart, worry, feeling overwhelmed | Busy or rushed settings feel like too much | Counseling, relaxation, daily routine |
| PTSD | Avoiding reminders, poor sleep, quick anger | Memory and focus problems that overlap with TBI | Trauma focused talk therapy |
Sources: TBI Model Systems factsheets [4, 7, 8, 12]; Grandhi review [5]; National Center for PTSD [10].
Sorting out what comes from where
After a concussion, it is often hard to say which symptom comes from which cause. The VA/DoD guideline notes that anxiety, depression, PTSD, chronic pain and headache can all complicate the picture [6]. The 2017 review goes further and says it is still unclear whether these problems are separate conditions or overlapping parts of the same injury [5].
The Living Concussion Guidelines, a Canadian guideline that is updated as new research appears, make a similar point in plain terms. Concussion symptoms are linked. One symptom can bring on others [11]. Mental health symptoms that were present before the injury, or that start after it, are linked to longer lasting postconcussion symptoms [13]. People who had depression or anxiety before a TBI may find those problems get worse afterward [8].
The review also describes studies that compared people with mild TBI to people with similar levels of pain but no brain injury. Most of those studies found no difference in test performance [5]. That hints that pain may explain part of the thinking trouble some people notice. It does not settle the question for any one person.
Your symptoms are real either way
The VA/DoD guideline asks providers to be careful when they talk with patients about what might be causing a symptom [6]. It recommends education that validates your symptoms and shows how other health conditions, and side effects of medicines, may make thinking harder [6].
How these conditions are checked
The adult Living Concussion Guidelines recommend checking whether mental health symptoms after a concussion meet the criteria for a condition such as depression, an anxiety disorder or PTSD [13]. A full assessment combines a clinical interview, short questionnaires and observation [13]. Information from family members or others who know you well can help too [13].
A 2025 U.S. guideline for adults with TBI gives screening a strong recommendation. Clinicians should check for new mental health conditions and for older ones that have gotten worse since the injury [14]. The guideline describes screening early, around one month after the injury, and again later [14].
Several short questionnaires are commonly used [13]:
- The PHQ-9 asks nine questions about depression.
- The GAD-7 asks seven questions about anxiety.
- A short five question PTSD screen was designed for use in primary care.
- The PCL-5 has 20 questions that match the 20 official symptoms of PTSD.
A high score on one of these forms is a signal to look more closely. The diagnosis itself comes from the full conversation with a qualified professional.
Who does the checking
You do not have to start with a specialist. The VA/DoD guideline favors a primary care approach that focuses on your symptoms for most people with mild TBI [6]. The Living Concussion Guidelines say a primary care provider can begin treatment, including education and medicine when it fits [13]. If symptoms are complex or severe, for example if there is any risk of suicide, the guideline calls for a referral right away to a licensed mental health professional [13].
You can help the visit go well. Keeping a journal of your mental health symptoms can be useful [11]. For pain, the TBI Model Systems suggest a two week pain diary that you bring to your next visit [12]. Tell every new provider about the crash and the concussion, even if the visit is about something else.
Treatments with good evidence
Guidelines agree that depression, anxiety and PTSD after a mild TBI should be checked and treated just as they would be in anyone else [6]. The Living Concussion Guidelines add that there is no evidence these conditions need different treatment because a concussion is involved [13]. Your therapist also does not have to be a concussion specialist [13].
For depression and anxiety
Antidepressant medicines and counseling both have good evidence for treating depression. Using them together tends to work best [4]. Cognitive behavioral therapy (CBT), a structured talk therapy that helps you change unhelpful thoughts and habits, may help some people with TBI [4]. The Living Concussion Guidelines recommend CBT and other talk therapies for mental health conditions after concussion [13]. Exercise treats mild to moderate depression in the general public, according to many studies [4]. For anxiety and emotional distress after TBI, medicine and counseling can both help [8].
For PTSD
The National Center for PTSD says effective PTSD treatments also work well for people who have had a mild TBI [10]. It names two trauma focused talk therapies, cognitive processing therapy and prolonged exposure [10].
For pain
The TBI Model Systems say most people with pain will benefit from help from a psychologist or another health care provider [12]. Exercise has proven benefits for pain. Pacing helps you keep doing what matters while saving energy [12]. For pain that lasts for months, most pain pills help little. Many of them can be habit forming [12]. When pain is feeding depression, the two should be treated together [7].
Medicines and thinking
The VA/DoD guideline advises avoiding medicines that can cause confusion after a mild TBI, such as benzodiazepines and anticholinergic drugs [6]. Ask about side effects on thinking whenever a medicine is added [9]. Do not stop or change any prescribed medicine on your own. Your prescriber or pharmacist can help you weigh the options safely.
Making therapy work with memory problems
Tell your therapist about the brain injury early on [8]. Ask for help writing down the main ideas so you can review them at home, and speak up if something needs to be repeated [8].
Everyday steps that protect your focus
Treatment takes time. In the meantime, a few habits can lower the load on your attention so more of it is free for remembering.
Checklist from Safety Behind the Wheel Foundation
- Keep a simple daily log of pain, mood, sleep and memory slips, and bring it to appointments [11, 12].
- Do one task at a time, and break big jobs into smaller steps [9].
- Plan breaks during tasks that take a lot of mental energy, then come back when you feel fresher [9].
- Practice deep breathing or muscle relaxation once or twice a day [8].
- Follow a daily schedule that includes some physical activity your care team has approved [8, 12].
- Bring an up to date list of every medicine and supplement you take.
- Ask someone you trust to come to important visits and take notes.
Mindfulness practice may also help with anxiety and focus, which in turn can ease pain [12].
A word about driving
After a crash, some people avoid driving or riding in a car. Both pain and PTSD can make people steer clear of certain places and activities [7]. If fear, flashbacks, pain, poor sleep or new medicines are affecting your focus, talk with your care team before you get back behind the wheel. A driving evaluation can help you decide when you are ready, and the rules about medical fitness to drive vary by state.
Get help right away
If you have thoughts of suicide or plan to harm yourself, call 988, call 911, or go to the nearest emergency room [4]. After a head injury, any of these danger signs means calling 911 or heading straight to an emergency room [1]:
- A headache that builds and does not let up.
- Weakness, numbness, poor coordination, convulsions or seizures.
- Vomiting over and over.
- Slurred speech or strange behavior.
- Pupils of uneven size, with one larger than the other.
- Not recognizing people or places, or confusion, restlessness or agitation.
- Passing out, extreme drowsiness, or being impossible to wake.
Questions to ask your care team
Question checklist from Safety Behind the Wheel Foundation
- Could pain, mood, worry or trauma stress be adding to my memory problems?
- Can you screen me with questionnaires such as the PHQ-9, GAD-7 or PCL-5?
- Which of my symptoms do you think come from the concussion, and which may have other causes?
- Could any of my current medicines be affecting my thinking?
- Would CBT or a trauma focused therapy help me, and how do I find a therapist?
- Should my pain and my mood be treated at the same time?
- Is there a pain program or pain psychologist you can refer me to?
- Which changes in my symptoms mean I should call you sooner?
- Is it safe for me to drive with my current symptoms and medicines?
Frequently asked questions
Will treating my mood or pain improve my memory?
Guidelines recommend treating these conditions because mental health symptoms are linked to longer recovery [13] and pain draws on the same attention you need to remember [5]. How much memory itself improves after treatment has not been well measured in mild TBI. Easing pain and distress should free up some attention, but how much that helps memory will differ from person to person.
Do I need a therapist who specializes in brain injury?
No. The Living Concussion Guidelines say the mental health professional does not need to specialize in concussion [13]. It helps to tell your therapist about the injury and ask for written notes of the main points [8].
Can PTSD therapy work if I also have a concussion?
Yes. The National Center for PTSD says effective PTSD treatments also work well for people who have had a mild TBI, including cognitive processing therapy and prolonged exposure [10].
Why would a mild injury cause more pain than a severe one?
Chronic pain was reported in about three out of four people with mild TBI, compared with about one in three after moderate or severe TBI [5]. Headaches after injury also show up more often after mild injury [6]. The reasons are not fully understood.
The bottom line
Recommendation from Safety Behind the Wheel Foundation
Pain, anxiety, depression and PTSD are common after a crash. Each can pull attention away from the work of remembering. They also overlap with concussion symptoms, so it often takes a careful look to see what is driving your memory trouble.
All four can be treated with care that has solid evidence, from CBT and trauma focused therapy to pain programs, exercise and, when needed, medicine. Start with your primary care provider, bring a symptom log, and ask for help right away if you ever feel unsafe.
Sources and further reading
- 1Centers for Disease Control and Prevention. Symptoms of mild TBI and concussion. Last reviewed September 2025. cdc.gov/…/index.html
- 2Stein MB, Jain S, Giacino JT, et al. Risk of posttraumatic stress disorder and major depression in civilian patients after mild traumatic brain injury: a TRACK-TBI study. JAMA Psychiatry. 2019;76(3):249-258. doi.org/10.1001/jamapsychiatry.2018.4288
- 3TRACK-TBI, University of California San Francisco. Mental health disorders common following mild head injury. January 2019. tracktbi.ucsf.edu/node/581
- 4Model Systems Knowledge Translation Center. Depression after traumatic brain injury. 2025. msktc.org/…/depression-after-traumatic-…
- 5Grandhi R, Tavakoli S, Ortega C, Simmonds MJ. A review of chronic pain and cognitive, mood, and motor dysfunction following mild traumatic brain injury: complex, comorbid, and/or overlapping conditions? Brain Sciences. 2017;7(12):160. doi.org/10.3390/brainsci7120160
- 6U.S. Department of Veterans Affairs, U.S. Department of Defense. VA/DoD clinical practice guideline for the management and rehabilitation of post-acute mild traumatic brain injury: provider summary. Version 3.0. 2021. healthquality.va.gov/…/VADoDmTBICPGProviderSummary…
- 7Model Systems Knowledge Translation Center. Chronic pain after traumatic brain injury (TBI): part 1. 2020. msktc.org/…/traumatic-brain-injury-and-…
- 8Model Systems Knowledge Translation Center. Changes in emotion after traumatic brain injury. 2022. msktc.org/…/changes-emotion-after-traum…
- 9Model Systems Knowledge Translation Center. Cognitive problems after traumatic brain injury. 2020. msktc.org/…/cognitive-problems-after-tr…
- 10National Center for PTSD, U.S. Department of Veterans Affairs. Traumatic brain injury and PTSD. Archived December 2020. webarchive.library.unt.edu/…/tbi_ptsd.asp
- 11Living Concussion Guidelines, patient version. Mental health symptoms. Ottawa Hospital Research Institute. Updated July 2025. concussionsontario.org/…/mental_health_symptoms
- 12Model Systems Knowledge Translation Center. Chronic pain after TBI: part 2. 2020. msktc.org/…/traumatic-brain-injury-and-…
- 13Living Concussion Guidelines. Section 8: Mental health disorders (adult guideline). Ottawa Hospital Research Institute. Updated April 2023. concussionsontario.org/…/mental-health-disorders
- 14Silverberg ND, Lee K, Mikolić A, et al. Action Collaborative on Traumatic Brain Injury Care: adapted clinical practice guideline. Annals of Family Medicine. 2025;23(6):552-569. doi.org/10.1370/afm.250352
This article reflects the safety priorities of brain injury recovery and road safety education. It offers general education and is not medical advice. Guidance changes over time, so check official sources and talk with your own care team about your symptoms, screening and treatment. If you are in crisis, call 988 or 911. Reviewed October 2026.
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