While not universal, for many persons with spinal cord injury, depression can be a complication that poses a significant impediment to their functioning and adaptation.
Identifying depression can be difficult, but is most likely to develop during the initial year post-injury. Though many will experience a remission of symptoms over time, for others depressive symptoms may persist for many years.
Self-report measures of depression should be viewed as screening tools to alert the clinician to arrange a more thorough evaluation. In addition to affective symptoms, endorsement of somatic symptoms (e.g. sleep disturbance, poor energy and appetite disturbance) during inpatient or outpatient contact merits clinical review to clarify possible mechanisms underlying their emergence.
There is level 2 evidence (from several studies; Table 2) to support the use of small group CBT based treatment packages to decrease depressive symptoms following SCI.
Follow-up findings (1 year post treatment) showed maintenance of affective improvement in four level 2 studies; conversely, evidence from two level 2 studies found that post intervention reduction of depressive symptoms were not sustained at follow up of up to one year.
There is level 1b evidence (from one randomized controlled trial; Schulz et al.,2009) that providing CBT to caregivers and care receivers results in improved depressive symptoms in care receivers.
There is level 4 evidence (from a pre-post study; (Migliorini et al., 2011) that computer based CBT may improve symptoms of depression, anxiety and stress post SCI.
Evidence of the benefits of pharmacotherapy alone and in combination with individual psychotherapy in the treatment of depressive symptoms in individuals with SCI is encouraging, although support is largely from investigations in other populations.
There is level 4 evidence (from one prospective controlled trial and three pre-post studies; Kahan et al.,2006; Kemp et al.,2004; Judd et al.,1989, 1986) indicating the effectiveness of pharmacotherapy combined with cognitive behavioral psychotherapy for treatment of depression in SCI and other chronic disabling conditions.
Regular physical exercise may contribute to a reduction of pain, stress, and depression as well as potentially offering a prophylactic effect on sources of recurrent pain and in preventing a decline in quality of life following SCI.
There is level 1a evidence (from three randomized controlled trials; Hicks et al.,2003; Ginis et al.,2003; Latimer et al.,2005) that exercise based programs reduced subjective pain, stress and resulting depressive symptoms.
There is level 1b evidence (from one randomized controlled trial and one pre-post study; Ginis et al.,2003) (Guest et al., 1997) that exercise reduces depressive symptoms.
There is level 2 evidence (from one cohort study; (Bradley, 1994) that individuals with unrealistic expectations report more depressive symptoms following a functional exercise stimulation exercise program.
There is level 2 evidence (from one randomized controlled trial; Zemper et al.,2003) that a wellness and health promotion program does not significantly decrease intensity of depressive symptoms.
There is level 2 evidence (from one prospective controlled trial; Dunn et al.,2000) that access to medical follow-up for individuals with SCI results in better health, independence, less depression and fewer secondary complications.
There is level 1b evidence (from one randomized controlled trial; Diego et al.,2002) that massage therapy can reduce depressive symptoms.
There is level 1b evidence (from one randomized controlled trial; (Defrin et al., 2007) for the effectiveness of transcutaneous magnetic stimulation in reducing depressive symptoms.