Depression is common among people who are paralyzed, but it's not normal -- becoming discouraged, grief-stricken or sad is normal, but depression represents a condition that is a health problem unto itself. Most forms of depression, however, can be treated.
While about 10 percent of the U.S. non-disabled population is said to be moderately or severely depressed, research shows that about 20 to 30 percent of people with long-term disabilities have a depressive condition.
Depression affects a person in many ways. It involves major changes in mood, outlook, ambition, problem solving, activity level and bodily processes (sleep, energy and appetite). It affects health and wellness: People with a disability who are depressed may not look after themselves; they may not drink enough water, take care of their skin, manage their diet. It affects one's social world. Friends and families are tuned out. Depressed people can't find pleasure, success or meaning. Substance abuse may develop. Thoughts of suicide often occur when things look most hopeless. In spinal cord injury, for example, risk is highest in the first five years after the injury. Other risk factors include dependence on alcohol or drugs, lack of a spouse or close support network, acess to lethal means, or a previous suicide attempt. People who've tried to kill themselves before are likely to try again. The most important factors in preventing suicide are spotting depression early, getting the right treatments for it, and instilling problem solving skills.
Many factors contribute to depression. These may include the effects of disability -- pain, fatigue, changes in body image, shame, and loss of independence. Other life events, such as divorce, loss of a loved one, loss of a job or financial problems can also lead to or magnify depression.
There are effective ways for helping people cope with the stresses of paralysis. Depression is highly treatable using psychotherapy, pharmacotherapy (antidepressants), or a combination of both. Tricyclic drugs (e.g., imipramine) are often effective for depression but may have intolerable side effects. SSRIs (Selective Serotonin Reuptake Inhibitors, e.g., Prozac) have fewer side effects and are usually as effective as tricyclics. SSRIs may exacerbate spasticity in some persons.
Among the newest antidepressants, venlafaxine (e.g., Effexor) is chemically similar to tricyclics and has fewer side effects. In theory, it may also alleviate some forms of neurogenic pain, a huge contributor to depression. In fact, aggressive treatment of pain problems is crucial to the prevention of depression.
Among those with MS, some experience mood swings and/or uncontrollable laughing or crying (called emotional lability). These result from damaged areas in emotional pathways in the brain. It is important for family members and caregivers to know this and realize that people with MS may not always be able to control their emotions. Mood stabilizing medications such as amitriptyline (e.g., Elavil) and valproic acid (e.g., Depakote) are used to treat these emotional changes. It is also important to recognize that depression is very common in MS -- even more so than in other equally disabling chronic illnesses.
Life is worth living, despite what health professionals are sometimes prone to judge: According to a Colorado survey, 86 percent of SCI high-level quadriplegics rated their quality of life as average or better than average, while only 17 percent of their ER doctors, nurses, and technicians thought they would have an average or better quality of life if they acquired quadriplegia.
If you are depressed, get help, including professional counseling or participation in a support group. An active lifestyle can also help to break through depression.
National Suicide Prevention LifelineNational Suicide Prevention Lifeline is a 24-hour, toll-free suicide prevention service available to anyone in suicidal crisis. If you need help, dial 1-800-273-TALK (8255).
The Reeve Foundation Paralysis Resource Center Information Specialists are reachable business weekdays, Monday through Friday, toll-free at 800-539-7309 from 9:00 am to 5:00 pm Eastern U.S. Time. International callers use 973-467-8270. You may also schedule a call or send a message online.
The information provided in the Paralysis Resource Center was supported by Cooperative Agreement number 1U59DD000838-01 from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the Reeve Foundation and do not necessarily represent the official views of the CDC.