Depression Table 2 Combined Psychotherapy and Pharmacotherapy for Treatment of Depression in SCI

Author Year
Country
PEDro Score
Research Design
Sample Size

Methods

Outcomes

Kemp et al. 2004
USA
Pre-post
NInitial=43; NFinal=28

Population: SCI: Age = 20-74 yr; Gender: males 32; females=11; Time since injury=5-37 yr; 28 treated for depression, 15 acted as quasi-controls. Depression status=major depression using OAHMQ
Treatment: 6 mo of individual outpatient treatment. Two components: psychotherapy and medication were offered to all. Cognitive behavior therapy began once a week for the first 2 months then was reduced to twice a month. All were prescribed an antidepressant based upon their needs and physician’s decision. Average number of therapy session completed was 14/17 (range 6-17).
Outcome Measures: OAHMQ,HDRS, Community activities checklist,LSS

  1. Depression Outcomes: A decrease was observed in depression scores from 0-24wk in the treatment group (p<0.001).
  2. Paired t-tests indicated a 24% decline in depression scores from 0-8wk (time 1=15.7, time 2=11.9, p<0.001) and from 8-24 wk (6.7) (p<0.001).
  3. 8 subjects continued to score in the range for major depression. If cases with variable treatment adherence were eliminated 100% of participants treated no longer had scores in the range of major depression.
  4. Community activities: There was a significant increase in community activities from 0-24 wk of treatment (p<0.001).
  5. T-tests showed a 40% increase in activities from 0-8wk (time 1=11.1, time 2=15.5, p<0.001).
  6. A further increase was noted between 8 and 24 wk (time 2=15.5, time 3=22.3, p<0.001). The correlation between the change in number of depressive symptoms and the change in the # of community activities was high (-0.81, p<0.001).
  7. Life satisfaction: While a significant overall effect was observed for life satisfaction scores (p<0.001), significant differences in life satisfaction were noted only between 8 and 24 wk (time 2=23.5, time 3=28.4, p<0.001).
  8. Non-treatment group: Scores on the depression measure did not change significantly over time.

Kahan et al. 2006
USA
Prospective Controlled Trial
Overall N=76; SCI N=41

Population: Treatment group: SCI=28, Other conditions=26; Mean age=51.4 yr Gender: males=52.7%, females=46.3%; Time since injury=26.2 yr; Quasi control group: SCI=13, Other=9; Mean age=44.2 yr; Gender: males=45.5%, females=54.4%; Time since injury=18.8 yr. Depression status=major depression evaluated using OAHMQ.
Treatment: Treatment group received a mixture of outpatient cognitive behavioral psychotherapy and antidepressant medication (individualized), for 30 wk.
Outcome Measures: OAHMQ-depression; LSS, The Community Activities Checklist – community activity involvement. Treatment group: @ baseline (T1), 10 weeks (T2) & 30 weeks (T3). Control group: @ 2 points (routine medical visits) spanning 2 years.

  1. Depression Outcomes: A decrease was observed in depression scores from 0-24wk in the treatment group (p<0.001).
  2. Paired t-tests indicated a 24% decline in depression scores from 0-8wk (time 1=15.7, time 2=11.9, p<0.001) and from 8-24 wk (6.7) (p<0.001).
  3. 8 subjects continued to score in the range for major depression. If cases with variable treatment adherence were eliminated 100% of participants treated no longer had scores in the range of major depression.
  4. Community activities: There was a significant increase in community activities from 0-24 wk of treatment (p<0.001).
  5. T-tests showed a 40% increase in activities from 0-8wk (time 1=11.1, time 2=15.5, p<0.001).
  6. A further increase was noted between 8 and 24 wk (time 2=15.5, time 3=22.3, p<0.001). The correlation between the change in number of depressive symptoms and the change in the # of community activities was high (-0.81, p<0.001).
  7. Life satisfaction: While a significant overall effect was observed for life satisfaction scores (p<0.001), significant differences in life satisfaction were noted only between 8 and 24 wk (time 2=23.5, time 3=28.4, p<0.001).
  8. Non-treatment group: Scores on the depression measure did not change significantly over time.

Judd et al. 1989
USA
Pre-Post
N=14

Population: Mean age=31.6 yr; Gender: males=9, females=5; Level of injury: paraplegia=7; tetraplegia=7; Depression status=clinically depressed evaluated using DSM-III.
Treatment: Patients received supportive psychotherapy and were prescribed tetracyclic and tricyclic antidepressants during rehabilitation period.
Outcome Measures: BDI

  1. 13 of the 14 patients had improvement in BDI score at discharge (average BDI at discharge=8).
  2. 1 patient required inpatient care in the psychiatric unit.

Judd et al. 1986
USA
Pre-Post
N=9

Population: Mean age=45.6 yr; Gender: males=8, females=1; Level of injury: tetraplegia=5; paraplegia=4. Depression status=clinically depressed evaluated using DSM-III.
Treatment: Patients were assessed within 2 wk of admission and prescribed either mianserin or nomifensine along with supportive psychotherapy.
Outcome Measures: HDRS

  1. All patients showed improvement in depressive and anxiety symptoms.
  2. Anxiety symptoms improved within the first wk while improvement in depressive symptoms did not occur until 3-6 wk post treatment.
  3. Side effects were minimal.

Note: *= if applicable;BDI=Becks Depression Inventory; HDRS=Hamilton Depression Rating Scale; LSS=Life Satisfaction Scale; OAHMQ=Older Adult Health & Mood Questionnaire.

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