SCI & Mental Health

Posted by Nurse Linda in Life After Paralysis on May 01, 2019 # Health

There is no denying that spinal cord injury has a huge impact on people’s lives, the individual with the spinal cord injury and those who love and care for that person. Every aspect of life changes with SCI from the onset of disease or trauma. Things that you took for granted now are planned and organized. Even the slightest of activities take much more time. You now must do things to protect yourself from secondary complications that you did not ever think about before. Let’s face it, some people have to plan their whole day around a bowel program.

It is no wonder that people can become frustrated, angry and depressed. I have yet to meet a person whose life goal is to become ill with a life-altering and progressive disease or to be involved in an accident where function becomes limited. Depression can happen to anyone, but it is also important to note that it does not happen to everyone.

Depression can be a response to severe illness or trauma. It is a physiologic response. Neurotransmitters, chemicals in the central nervous system that send messages, become affected in depression. Does that sound familiar to you? It should because, in spinal cord injury, neurotransmitters are affected at the site of injury. The locations might not be the same, as depression takes place more in the neurotransmitters of the brain whereas, in SCI the affected neurotransmitters are in the spinal cord.

Exactly how spinal cord injury and depression are physiologically related is unclear. However, we do know that there are changes to the nervous system with both. Immediately, there is the acute internal crisis and reaction by the body when spinal cord injury occurs from either medical or traumatic causes. After spinal cord injury, there are changes in the body as it attempts to protect and repair itself. Inflammation as the body attempts to heal itself is just one example.

There are links of depression being caused by a variety of factors. Genetics seems to play a part in that depression tends to run in family lines. There may be links by gender to depression in that men seem to become more stressed to partner separation and work issues while women have more stress with interpersonal relationships, illness, and death. There are also theories about the chemical causes of depression. In the midbrain and brainstem, the monoaminergic systems effects mood, attention, and reward among others. Gamma-aminobutyric acid (GABA) in the brain is another. What all of this effectively tells us is that chemical imbalances have an effect on depression.

If the physiology of spinal cord injury has a direct effect on the development of depression is unknown. Logic clearly points to a relationship, but some people seem to have more serious cases of depression. Or do they? Some people cover it better. Some keep their feelings hidden. Some have a ‘public face’ while others are easier to express their thoughts.

Some medical diagnoses affect the central nervous system in different ways. One such example is Multiple Sclerosis. Depression can slip in two different ways. One can be from the body’s response to major illness. The other is through significant life changes.

Hardiness is a psychological term for how people deal with challenges in life. This is more than just outward appearances but an internal response. Some people seem to deal with problems differently than others. There is no determination for who is hardy and who is not. It could be an internal determination. It could be the way you were raised to meet challenges. More than likely, it could be a combination of both.

Depression can come in waves. An initial trigger may or may not be present. However, a spinal cord injury certainly can be a significant trigger. As life moves on, people can have significantly severe episodes as new challenges appear. The name for this is chronic sorrow. It occurs when you think you have a situation under control only to be faced with a new challenge, an unkind word or action and, boom, you are drawn right back into the depths. This can happen to individuals living with SCI as well as family members.

For individuals with spinal cord injury just as with anyone, depression can appear at any time. There is no pattern to the development of depression after SCI. However, people with spinal cord injury seem to have certain periods in particular. Immediately after the injury or illness is a very susceptible time. For some people, depression might not hit early as they fill their days with making sure they are doing everything to help themselves. Then after about one to two years, depression hits strongly. Sometimes, this response does not come until as late as 5 years later. It appears to be almost a defense mechanism of doing everything right but when a complete recovery does not appear, depression does. After this initial period, depression can appear at any time or be ongoing.

There are signs of depression but detecting them can be difficult. Some people will just say, you have had a huge life change, depression will appear. This is called situational depression. Take away the situation and the depression would be gone.

Some of the symptoms of depression include changes in sleep or appetite as in too little or too much. Feeling sad or hopeless, loss of interest in activities that you like to do, low energy, difficulty in concentrating or making decisions, feeling worthless, thoughts of suicide or death are other symptoms. Reviewing the list, these are all feelings that people have periodically but lingering feelings or feeling these often is a definite sign of depression. Having a spinal cord injury can result in some of these feelings without being depressed. You can be really tired from moving about or lose interest in activities because you might think you cannot do them as before your SCI. Some medications can lead to these symptoms especially medications taken by mouth for spasms can make thinking a challenge.

Here is the good news for depression. It is treatable. Medications can help restore brain chemicals. Counseling is extremely useful in organizing your thoughts and feelings as well as developing strategies to deal with difficult situations. Depression is a medical condition. It is not something that you can just ‘tough it out’. It is an actual physiologic problem that can be treated. The important step you need to take is to tell someone who can help you. Your healthcare professional can provide the treatment you need to control depression.

You need to seek help for depression but there are also things you can do to help yourself. These do NOT take the place of getting treatment. None of these suggestions are easy nor are they going to happen overnight. You have to work endlessly to reach the goal of changing your mindset.

First, realize that you will be doing things differently. This is a new normal for you. Incorporate the tasks you need to accomplish into your normal. Instead of planning all day for that bowel program, rethink about the time it will actually take. Then just think about it at that time. If it takes some time, what can you do while you wait? If the bowel program is taking longer than 20 minutes, find out how you might be able to shorten the time. Use the Nike slogan when you can. For instance, find a trigger to do a pressure release and "Just Do It". Integrate your care into your daily routine instead of having your routine rule you. This is a mind reset.

Stop negative talk. This is that not so little voice in your head that tells you that you can’t, or you are not worthy of any other self-destructive notion. Lots of people do this with or without SCI. I will use myself as an example as I was the Queen of this self-destructive behavior. It took me more than five years to change this mindset and, guess what, I still fall into it on occasion. We all do but I don’t put myself down when I fall back. It is just another opportunity to catch myself and compliment me on noticing. It is not a self-glory party, but an acknowledgment that we are all human and worthy of good things in our lives.

This next improvement act is going to sound mundane, but science says it is true. Count your successes. Some people will call it counting their blessings. You have family, shelter, food. But you have a lot more. Perhaps you hit all of your pressure releases today. Maybe you found a way to improve that bowel program. It could be that you strengthened your arms toward your goal of driving on your own. Set the goals that you are working toward now and celebrate each incremental step. Be proud of yourself because you are making it. If you are reading this blog, you are making it.

A very important step is to get involved with people. Be kind to those who care for you. Get to know people in your local community. Get to know people in the spinal cord community. People are our greatest source of comfort and power. You can get valuable knowledge from folks who have lived through all sorts of experiences. Even more, you can provide help to those who are going through what you have already mastered. It feels good to help others.

All of these activities release good chemicals in the brain. This helps you in your fight against depression. Be sure to check out the community, Reeve Connect, on this website. It is inspiring.

Pediatric Consideration: Childhood depression can be difficult to see as it is often masked. Children will accept themselves as they are until a difference is pointed out. For parents, guilt is a challenge to keep in check. Parents often assign guilt to themselves where there is none. Keep your mental health well.

Hasler, G. (2010). Pathophysiology of depression: Do we have any solid evidence of interest to clinicians? World Psychiatry, 9(3), 155-161.

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