Pharmacotherapy is a commonly prescribed for treatment of depression post SCI. Poor tolerance to pharmacotherapy may lead to exacerbation of other secondary issues such as spasticity (Stolp-Smith & Wainberg 1999). However, research on its efficacy among persons with SCI is limited.
Four studies examined the effect of pharmacotherapy alone in the reduction of depressive symptoms post SCI (Fann et al. 2015; Richards et al. 2015; Rintala et al. 2007; Salinas et al. 2012). Richards et al. (2015) found venlafaxine resulted in significant improvement in pain interference of mood among those with noiciceptive pain compared to placebo. No significant effect of venlafaxine was seen among those with neuropathic or mixed pain. The remaining three studies found no significant improvement in depressive symptoms after amitriyptyline (Rintala et al. 2007), gababentin (Rintala et al. 2007), and carbamazepine (Salinas et al. 2012) compared to placebo. Fann et al. (2015) reported significant decrease in depressive symptoms based on the Maier subscale of the HAM-D among persons receiving venlafaxine compared to placebo.
There is limited evidence that carbamazepine, amitriptyline, and gabapentin may not improve symptoms of depression post SCI.
There is level 1b evidence (Fann et al. 2015) that venlafaxine improves depressive symptoms post SCI.
There is level 1b evidence (Richards et al. 2015) that venlafaxine improves pain interference with mood post SCI.