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 Depression is found two or three times more often among people who are paralyzed than among the nondisabled – it is common but not normal. Becoming discouraged, grief-stricken or sad is normal, but depression is a health problem unto itself. Most types of depression, however, can be treated.
Depression affects a person in many ways. It affects mood, outlook, ambition, problem solving, activity level and bodily processes such as sleep, energy and appetite. Depression works against 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, or manage their diet. It affects one's social world: Friends and families are tuned out. Depressed people can't find pleasure, success or meaning; it is a fertile ground for substance abuse. Thoughts of suicide often occur when things look most hopeless.
Many factors contribute to depression. These may include the physical effects of disability including pain and fatigue. Psychological issues may stem from changes in body image 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.
In the SCI population, however, extra care must be given regarding prescription drugs. The side effects of various antidepressants may have serious consequences for appetite or weight gain in the wheelchair user, or weight loss in a person with a pressure sore. The most common side effects of antidepressants are constipation, daytime sleepiness, diarrhea, dizziness, dry mouth, headache, nausea, sexual problems, shakiness, trouble sleeping, and weight gain. Many side effects go away after a few weeks; some only go away after you stop the medicine. SSRIs may exacerbate spasticity in some persons.
Antidepressants seem to work by restoring balance to important brain chemicals. This leads to feeling better emotionally and in many cases, physically. Tricyclic drugs are often effective for depression but may have intolerable side effects. Selective Serotonin Reuptake Inhibitors, e.g., Prozac) have fewer side effects and are usually as effective as tricyclics.
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.
People with major depression may be at risk for suicide. 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, 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 and getting the right treatments for it. 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.
Note to caregivers, families and friends of people with SCI: Changes in behavior and mood can be gradual. Sometimes it's easier for others to see such changes first. If you care for a person with SCI and see signs of depression (sadness, feelings of worthlessness, trouble sleeping, lack of energy or concentration, etc.), express your concern, and encourage the person to see a physician or mental health specialist right away.
Caregiver depression is quite common too: Watch for signs of depression in yourself, too. You can't "catch" depression but it can be depressing to be around a depressed person. If you're feeling down or blue or helpless about helping someone, find someone to talk to, someone you trust: a counselor, your primary care physician, a friend.
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