Most of what gets said after a head injury covers the first two weeks. Rest, limit screens, watch for vomiting or a headache that keeps building, come back if anything changes fast. What tends to go unsaid is what week eight can look like, after the headaches have settled, when a person feels flat, short with the people closest to them, and indifferent to things that used to hold their attention.
Low mood that shows up after a concussion, a crash on I-70, a fall on an icy porch, or a hit taken in a game is common enough that clinicians expect to see it. Name it out loud in the exam room rather than chalking the whole stretch up to being tired. This page is about what that evaluation looks like in Missouri, who does it, and what the visit itself involves.
Why mood gets raised after a head injury
Two things tend to be going on at the same time, and they are nearly impossible to tell apart from the inside. A head injury can change sleep, attention, tolerance for noise and light, and how fast someone runs out of energy in an afternoon. Depression changes many of the same things. A person who sleeps badly and loses the thread of a conversation may be depressed, may still be coming back from the injury, may be both, and there is no lab value that separates the two.
Then there is everything that happened around the injury. A wreck can cost someone weeks of work, a vehicle, a sport, or the plain sense that their own body is predictable. Grief and money pressure do not need a mechanism in the brain to pull mood down. A careful evaluation takes both tracks seriously rather than settling on one early.
There is a third reason the injury belongs in the conversation. Among people whose depression has not eased after the first few medications, a history of head injury turns up more often than chance alone would explain. Call it a piece of background worth having on the record, nothing more. A risk factor is not a finding, and by itself it is no reason for anyone to steer a plan toward ketamine or the newer options at all. The difference it makes is in the sharpness of the questions asked. A clinician who knows about the 2009 football season, or the rollover in 2016, asks about timelines and symptoms that otherwise never come up.
Where an evaluation can happen in Missouri
For most people the first door is primary care, and that is a reasonable door. A family physician or nurse practitioner can take the history, check the ordinary medical contributors such as thyroid trouble or low iron, review what medications are already in play, and decide whether a referral is worth making. Arriving with the injury written down shortens that visit considerably.
Academic medical centers carry the deepest bench for complicated histories. Columbia, Kansas City, and the St. Louis area all have university affiliated systems where behavioral health sits close to neurology and rehabilitation medicine, which matters when someone needs formal neuropsychological testing rather than a questionnaire. Springfield, Joplin, Cape Girardeau, and St. Joseph have regional hospital systems with outpatient behavioral health, and waits there are sometimes shorter than in the two large metros.
Community mental health centers cover much of rural Missouri, and most of them work on a sliding scale, which is the practical answer for someone without coverage. Veterans travel a different road through the VA, whose Missouri hospitals sit in Kansas City, Columbia, Poplar Bluff, and the St. Louis area, and a referral out to community care becomes possible once the drive or the calendar makes an internal visit unworkable.
There are also outpatient clinics that concentrate on depression that has not lifted under standard treatment, and some of them write openly about patients whose symptoms began after an impact. Reading how a clinic describes the stretch of time what the clinic says about the months after an accident will tell you something about how carefully that history gets handled, before you ever pick up the phone.
What the evaluation actually involves
Expect most of it to be conversation. A clinician will want the date, or at least the rough season, of the injury, what happened, whether consciousness was lost, whether anyone examined you at the time, and what the first month afterward was like. Then the present: sleep, appetite, concentration, irritability, alcohol use, and any thoughts of harming yourself. Standardized questionnaires are routine, and they are screening instruments, not verdicts.
Imaging is often not ordered, and when it is ordered it frequently comes back looking normal. That is expected with concussion and it does not mean the symptoms were imagined. Neuropsychological testing is a different animal: several hours of structured tasks that map attention, memory, and processing speed, usually arranged when the cognitive complaints are the loudest part of the picture.
What comes out of a first visit is usually a working plan rather than an answer. That might mean addressing sleep first, a referral for therapy, a medication trial with a defined check in date, or further testing. Ask what the next decision point is and when it arrives, so the plan has an edge to it instead of drifting into next year.
Bringing the history with you
Write the injuries down before the appointment, including the ones that felt minor at the time, with the year and one line about what happened. Note when the mood change started relative to those dates. Bring a list of every medication tried for mood, including the ones that were stopped, with a guess at the dose and how long each lasted. That single page does more work than anything you can improvise in the room.
If things are bad right now, the 988 Suicide and Crisis Lifeline answers by call or text, around the clock, in Missouri as everywhere else in the country. Reaching out on a day when you feel flat rather than desperate still counts as a step.