The National
Spinal Cord
Injury Association

SCI Life
Fall/Winter 1998

Depression: What the Consumer Needs to Know

What is Depression?
Depression is a psychological condition involving major changes in mood, outlook, ambition, thinking ability, activity level and bodily processes (such as sleep, energy, and appetite). While about 11% of the U.S. non-disabled population is moderately or severely depressed at any given time, research shows that about 30 - 40% of people with long-term spinal cord injury (SCI) have a depressive condition.

Who is Affected?
Depression affects the person's health, interpersonal relations, work, and ability to enjoy life. People with SCI who are depressed do not look after themselves well; they may not drink enough water, look after their skin, manage their diet or see their doctors. They may appear moody or irritable to others, not go out with friends, and lose interest in romance. Work or other activities suffer because the person loses interest, can't problem solve well or is hard to get along with. Life becomes less enjoyable because the person loses some of the ability to find pleasure, success or meaning on life. Often, substance abuse develops to help cope with painful feelings. If depression is severe, thoughts of suicide often occur.

What Causes Depression?
No one is exactly sure, but a combination of life stress and physical changes in the brain seem most likely. Some depression is inherited, but only in a small percentage of cases. People with SCI can become discouraged and depressed as they age if they lose the ability to perform valued activities or if they find it hard to cope with these changes. Depression is not the result of being "weak", "immature", or "inadequate." Depression is a health condition. Persons with both paraplegia and quadriplegia develop depression in nearly equal numbers.

Isn't Depression Normal?
No, depression is not normal, even in the face of a spinal cord injury. Becoming discouraged, grief-stricken or sad is normal but depression represents a condition that goes beyond these normal reactions and indicates that the person has a new health problem.

What Can Be Done?
Fortunately, most depression is readily treated. Depending upon its severity, most people, when properly assisted, will experience significant improvement within a few weeks and complete improvement within 6 to 12 months. Treatment usually involves medicines and/or psychotherapy. Psychotherapy of a practical, problem-solving variety has proven best. Modern medicines are safe and effective for people with SCI when properly selected and monitored. Improvements in the symptoms of depression quickly lead to improvement in other areas, including personal relations, motivation, health and quality of life.

How Do I Recognize Depression?
Because depression develops slowly, people just kind of slip into it. One way to help determine if you need a formal evaluation is to take the following quesionnaire. Answering "true" to 0 to 4 statements indicates nominal responses to everyday life. Answering "true" to 5 to 10 indicates a moderate degree of depression that can affect health, functioning and outlook. More than 10 "true" answers indicate a possible major depressive problem that severely affects functioning and health.

What to Do Next.
If you answered "true" to more than 6, and definitely if more than 10, you should make an appointment with your primary care provider, a psychologist or psychiatrist and discuss the problem. They also can make arrangements for tests to make sure you're not suffering from something else (like an under-active thyroid or an infection). After that, treatment can be started and you can begin feeling better soon.

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