Depression is common and can affect anyone. About 1 in 20 Americans (over 11 million people) become depressed every year. Depression is even more common in the spinal cord injury (SCI) population— about one in five people. Estimated rates of depression among people with SCI range from 11% to 37%.
What is depression?
Depression is not just “feeling blue” or “down in the dumps.” It is a serious medical disorder (just like diabetes, in which both biology and behavior can help or
hurt). Depression is closely linked to your thoughts, feelings, physical health and daily activities. Depression affects both men and women. Depression can
cause some or all of the following physical and psychological symptoms:
- Changes in sleep (too much or too little)
- Feeling down or hopeless
- Loss of interest or pleasure in activities
- Changes in appetite
- Diminished energy or activity
- Difficulty concentrating or making decisions
- Feelings of worthlessness or self-blame
- Thoughts of death or suicide
Causes of depression
Although we don’t know for sure what causes depression, we do know that life stresses and medical problems can cause a change in certain brain chemicals,
called neurotransmitters. This chemical imbalance is linked to changes in mood, enjoyment, sleep, energy, appetite and ability to concentrate.
"Depression can make pain worse, make sleep difficult, sap your energy, take away your enjoyment and make it difficult for you to take good care of your health."Charles H. Bombardier, PhD, in collaboration with the University of Washington Model Systems Knowledge Translation Center
Depression can and should be treated
The good news is that the symptoms of depression can almost always be treated with specific types of counseling or antidepressant medications. However, a combination of both counseling and antidepressant medication has been shown to have the best results. Regular exercise or physical activity can also improve mood, especially when used together with counseling. Depression & Spinal Cord Injury It is important to treat depression because it can have such a harmful effect on a person’s ability to function in day-today life.
Depression can make pain worse, make sleep difficult, sap your energy, take away your enjoyment and make it difficult for you to take good care of your health. Untreated depression can last 6 to 12 months or more. Thoughts of death are a symptom of depression. The risk of suicide is higher while someone is depressed. Due to both brain chemistry and thought patterns, often people who have severe depression and suicidal thoughts have difficulty seeing a way out of their problems. Suicidal thinking goes away once depression is treated.
What counseling really is
Counseling or psychotherapy is often misunderstood.There are many different kinds of therapy, but one type that has been proven to help depression is called “cognitive-behavioral therapy.” Cognitive-behavioral therapy is based on the idea that depression improves when people are more engaged in meaningful activities and when they regain their positive beliefs and attitudes about themselves, their world and their future. The therapist helps you find or resume activities that are meaningful or enjoyable to you. There will be barriers to overcome, so the therapist supports you like a coach to help resolve the problems you face. The therapist also helps you recognize how your thinking becomes more negative in depression and how, through experimentation and logic, you can improve your outlook and rebuild confidence.
How do antidepressants work?
Antidepressant medications seem to work by restoring a normal balance of important brain chemicals such as norepinephrine and serotonin. Rebalancing these chemicals leads to feeling better both emotionally and physically. Treating depression can also help you function better at home and at work. Antidepressants are not addictive. Some people experience side effects, but they tend to lessen over time.
For each of the nine items listed below, circle the number (0-3) that corresponds to how often you have been bothered by that problem over the past two weeks.
What you can do
1. Take a “depression self-test” like the one above.
2. Answer all the questions honestly, add up your score and see where your score falls.
3. If your score is 10 or higher and you have been feeling this way for more than a week or two, contact your health care provider or a psychologist, psychiatrist or
counselor who has experience treating depression.
4. If you are having thoughts of death or suicide, contact your health care provider or a mental health specialist immediately. Also, inform those around you about how badly you are feeling so that they can support you and help keep you safe while you go through this difficult period.
If you are in danger of harming yourself now, please call 911, the 24-hour National Crisis Hotline at 800-273-8255, or your local Crisis Clinic right away.
Remember, depression is not a necessary or inevitable part of living with SCI. In fact, most people with SCI are not depressed. If you are struggling with depression or feeling low for more than two weeks, talk to your doctor. Depression is treatable and beatable.
How to find help
Many mental health professionals are qualified to treat depression. For example, psychiatrists have specialized training in medication management for depression and psychologists are trained to provide counseling for depression. Other physicians, such as primary care physicians, neurologists and physiatrists, and nurse practitioners with experience in treating depression can often get treatment started and refer you to mental health professionals when needed. When available, seek treatment from a comprehensive spinal cord injury rehabilitation program that can address all aspects of SCI recovery.
Authorship: Depression and Spinal Cord Injury was developed by Charles H. Bombardier, PhD, in collaboration with the University of Washington Model Systems Knowledge Translation Center.