Authors: SCIRE Community Team | Reviewed By: Brad Hallam, Ph.D., R.Psych., ABPP-CN | Last updated: May 7, 2020
Depression is one of the most common mental health concerns among people living with spinal cord injury (SCI). This page provides an overview about what depression is and common treatments for depression after SCI.
- Depression is a psychological disorder involving a sad or depressed mood, loss of interest in activities, and many other symptoms.
- Depression is common but not universal after SCI.
- Depression is treatable. There are many effective treatments for depression, including antidepressant medications, counseling and talk therapies, and exercise programs.
- Research suggests that [glossary_exclude]cognitive behavioural therapy[/glossary_exclude], antidepressant medications, exercise programs, or a combination of these interventions may help to improve depression after SCI.
Depression (major depressive disorder) is a psychological disorder which involves depressed mood, loss of interest in activities, and a number of other symptoms that affect emotions, thoughts, behaviours, and the body.
Depression is not simply ‘feeling blue’ or the sadness that can accompany life events like the death of a loved one. It is a serious medical condition involving persistent and widespread feelings of distress that affect all aspects of a person’s life.
The main symptoms of depression are a depressed mood and/or a loss of interest or pleasure in activities. Other symptoms may include some or all of these physical, emotional and cognitive (thinking) symptoms:
- Changes in weight or appetite
- Changes in sleep – either sleeping too much or too little
- Moving or speaking slowly, or being fidgety and restless
- Feeling tired or low energy
- Feeling ‘down’, sad, or empty
- Feeling worthless, hopeless, or guilty
- Feeling irritable or angry
Cognitive (Thinking) Symptoms:
- Trouble concentrating or making decisions
- Thinking about death or suicide
Symptoms have to last for at least two weeks and be severe enough to interfere with the person’s life to be diagnosed as depression.
Depression affects everyone differently, so its exact symptoms will be different from person to person. Depression is not always easy to recognize. If you suspect that you or a loved one may have depression, it is important to speak to a healthcare provider for more information.
Depression is one of the most common mental health concerns after SCI. As many as 40% of people experience depression during rehabilitation and around 1 in 5 people experience depression a year after the injury.
Depression can be a serious problem after SCI. It can interfere with recovery and rehabilitation and is related to longer hospital stays, higher levels of pain, and lower quality of life after injury.
However, it is also important to keep in mind that not every person will develop depression after SCI. The majority of people adapt well to living with an SCI and depression is not a necessary part of adjustment to injury, but shows that a person is experiencing distress.
Hear Louise describe her experience with being told “you can’t walk again”
Scientists do not know for sure what causes depression. Depression can affect anyone and happens for different reasons for each person. There are many different factors that may be related to depression, such as:
- Stressful life events, like experiencing a serious injury or losing a job
- Personal characteristics, such as personality and life experiences
- Environmental factors, such as social support and personal security
- Medical conditions
- Certain medications
Depression may be related to lower levels of certain brain chemicals called [glossary_exclude]neurotransmitters[/glossary_exclude]. [glossary_exclude]Neurotransmitters[/glossary_exclude] are chemicals in the brain that allow nerve cells to send messages. Lower levels of certain [glossary_exclude]neurotransmitters[/glossary_exclude], including serotonin, norepinephrine, and dopamine, are linked with depression. However, this is a complex relationship that scientists are still working to understand.
Depression is diagnosed through interviews with a health provider such as a doctor or psychologist. The health provider will ask questions about mood and a number of other symptoms, and may have you [glossary_exclude]complete[/glossary_exclude] questionnaires about your symptoms.
There is no lab test that can diagnose depression, but lab testing may be done to rule out other conditions that may have similar symptoms, such as thyroid problems.
There are many different ways of treating depression. The first treatments are usually counseling and talk therapies and antidepressant medications. Other treatments for depression may include exercise and a number of other medical, [glossary_exclude]alternative[/glossary_exclude], and self-help therapies.
Counseling and Talk therapies
Counseling and talk therapies involve talking with a mental health provider such as a psychologist, counselor, or social worker. There are many different types of talk therapies. Research done on depression after SCI has focused primarily on one type of therapy called cognitive behavioural therapy or [glossary_exclude]CBT[/glossary_exclude].
[glossary_exclude]Cognitive behavioural therapy[/glossary_exclude] is a type of therapy that addresses how thoughts, feelings, and behaviours can contribute to mental health problems. It focuses on developing practical skills to help manage these conditions and can be done in many different formats, including one-to-one counseling, group therapy, and computer programs.
There is moderate evidence that [glossary_exclude]cognitive behavioural therapy[/glossary_exclude] can help to improve depression symptoms after SCI. However we do not know whether these effects last long-term.
Antidepressant medications (antidepressants) are another common treatment option for depression. There is a wide range of different antidepressants that may be used. Some antidepressant medications can treat sleep, nerve pain and mood simultaneously, and these are often used in people with SCI. Antidepressants are prescribed by medical doctors.
The use of antidepressants to treat depression after SCI is mostly based on research studies done in the general population because there are not many studies done among people with SCI. However, there is weak evidence that combined antidepressant medications and talk therapies may help to improve the symptoms of depression among people with SCI.
Exercise is now becoming more widely known as a treatment option for depression. Exercise may help treat depression because it helps to reduce pain and stress, cause the release of ‘feel-good’ chemicals like endorphins, and helps to maintain mobility and quality of life.
A number of different exercise-based programs have been studied for their effects on depression, after SCI. There is strong evidence that exercise helps to reduce the symptoms of depression after SCI.
Other treatments and strategies for depression
There are many other treatments used for depression. These treatments have not been studied extensively among people with SCI, so we do not know how effective they are for depression after SCI.
- Organized wellness and health promotion programs
- Living a healthy lifestyle (getting enough rest, eating healthy, and staying active)
- Participating in enjoyable activities
- Meditation and mindfulness training
- Massage therapy
- Light therapy
- Herbal and dietary supplements
- Brain stimulation therapies such as Transcranial Magnetic Stimulation (TMS)
Addressing other medical problems
There are a number of factors related to spinal cord injury that may contribute to depression, such as chronic pain, fatigue, sleep problems, medication side effects, and health problems like repeated infections. Treating these problems may be another strategy that can help manage depression.
Evidence for “How is depression after SCI treated?” is based on the following studies:
Counseling and Talk Therapies
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