Rehabilitation Evidence > Depression > Summary

Summary

Submitted by admin on Wed, 05/19/2010 - 17:52
  • While not universal, for many persons with spinal cord injury, depression can be a complication that poses a significant impediment to their functioning and adaptation.
  •  Identifying depression can be difficult, but is most likely to develop during the initial year post-injury. Though many will experience a remission of symptoms over time, for some individuals, depressive symptoms may persist for many years.  
  • Self-report measures of depression should be viewed as screening tools to alert the clinician to arrange a more thorough evaluation.  In addition to affective symptoms, endorsement of somatic symptoms (e.g. sleep disturbance, poor energy and appetite disturbance) during inpatient or outpatient contact merits clinical review to clarify possible mechanisms underlying their emergence.
  • There is level 2 evidence from 6 studies supporting the use of small group CBT based treatment packages to decrease depressive symptoms following SCI.
  • Follow up findings (up to 1 year post treatment) showed maintenance of affective improvement in 4 level 2 studies. Conversely, evidence from 2 level 2 studies found that post intervention reduction of depressive symptoms were not sustained at follow up (up to 1 year).
  • One level 2 study did not identify significant improvement in depressive symptoms.
  • Evidence of the benefits of pharmacotherapy alone and in combination with individual psychotherapy in the treatment of depressive symptoms individuals with SCI is encouraging, although support is largely from investigations in other populations.
  • There is level 4 evidence from four non-RCT studies indicating the effectiveness of pharmacotherapy combined with cognitive behavioral psychotherapy for treatment of depression in SCI and other chronic disabling conditions.
  • Regular physical exercise may contribute to a reduction of pain, stress, and depression as well as potentially offering a prophylactic effect on sources of recurrent pain and in preventing a decline in quality of life following SCI. 
  • There is level 1 evidence from 2 RCTs and level 2 evidence from 1 RCT that exercise based programs reduced subjective pain, stress and resulting depressive symptoms.
  • There is level 1 evidence from 1 RCT and level 4 evidence from 1 pre-post study that exercise reduces depressive symptoms.
  • Level 2 evidence from 1 cohort study of individuals with unrealistic expectations report more depressive symptoms following an FES exercise program.
  • There is level 2 evidence from 1 RCT suggesting a wellness and health promotion program did not significantly decrease intensity of depressive symptoms.
  • In 1 non-RCT, access to medical follow-up for individuals with SCI found reports of better health, independence, less depression and fewer secondary complications. 
  • There is level 1 evidence that massage therapy can reduce depressive symptoms
  • There level 1 evidence for the effectiveness of TMS in reducing depressive symptoms.