Kemp et al. 2004
USA
Downs & Black score=20
Pre-post
Initial N=43; Final N=28

Population:  SCI: Age = 20-74 yrs; Gender: males = 32; females = 11; Time since injury = 5-37 yrs; 28 treated for depression, 15 acted as quasi-controls. Depression status=major depression using OAHMQ
Treatment: 6 months of individual outpatient treatment.  2 components-psychotherapy and medication were offered to all.  Cognitive behavior therapy began once a week for the first 2 months then was reduced to twice a month.  All were prescribed an antidepressant based upon their needs and physician’s decision. Average number of therapy session completed was 14 out of 17 (range from 6 to 17).
Outcome Measures: OAHMQ,
HDRS, Community activities checklist,
LSS

1. Depression Outcomes: A decrease was observed in depression scores from 0-24wks in the treatment group (p<0.001).
2. Paired t-tests indicated a 24% decline in depression scores from 0-8wks (time 1=15.7, time 2=11.9, p<0.001) and from 8-24wks (6.7) (p<0.001).
3. 8 subjects continued to score in the range for major depression. If cases with variable treatment adherence were eliminated 100% of participants treated no longer had scores in the range of major depression.
4. Community activities: There was a significant increase in community activities from 0-24wks of treatment (p<0.001).
5. T-tests showed a 40% increase in activities from 0-8wks (time 1=11.1, time 2=15.5, p<0.001).
6. A further increase was noted between 8 and 24 weeks (time 2=15.5, time 3=22.3, p<0.001). The correlation between the change in # of depressive symptoms and the change in the # of community activities was high (-0.81, p<0.001).
7. Life satisfaction: While a significant overall effect was observed for life satisfaction scores (p<0.001), significant differences in life satisfaction were noted only between 8 and 24 weeks (time 2=23.5, time 3=28.4, p<0.001).
8. Non-treatment group: Scores on the depression measure did not change significantly over time.

Kahan et al. 2006
USA
Downs & Black score=18
NonRCT
Overall N=76; SCI N=41

Population: Treatment group: SCI = 28, Other conditions = 26; Mean age = 51.4 yrs Gender: males = 52.7%, females = 46.3%; Time since injury = 26.2 yrs; Quasi control group: SCI = 13, Other = 9; Mean age = 44.2 yrs; Gender: males = 45.5%, females = 54.4%; Time since injury = 18.8 yrs. Depression status=major depression evaluated using OAHMQ.
Treatment: Treatment group received a mixture of outpatient cognitive behavioral psychotherapy and antidepressant medication (individualized), for 30 weeks.
Outcome Measures: OAHMQ-depression; LSS, The Community Activities Checklist - community activity involvement. Treatment group: @ baseline (T1), 10 weeks (T2) & 30 weeks (T3). Control group: @ 2 points (routine medical visits) spanning 2 years.

1. Depression Outcomes:

Depression rate of the treatment group was improved between all time points (p≤0.001).

1. At baseline, OAHMQ scores in 53/54 treatment subjects classified as “experiencing major depression” and 1/54 had “significant depression symptoms”. By T3, 41 subjects classification had improved and 13 remained the same with an improved OAHMQ score (p≤0.001). Overall, 71% of SCI subjects’ depression improved following treatment.
2. At baseline, treatment and control groups’ depression scores were similar, but were significantly different after treatment (p≤0.001). Mean depression scores reduced by 50% & 12% in treatment & control groups, respectively.
3. Community activity scores: Improved scores for the treatment group (p≤0.001). 2, 14 & 22 subjects engaged in 25+ activities/week at T1, T2 & T3, respectively.
4. SCI subjects were found to participate in a significantly fewer community activities, as compared to other subjects, (p≤0.05).
5. Life satisfaction: Scores improved for the treatment group (p≤0.001). 9, 16 & 30 subjects were “mostly to very satisfied” @ T1, T2 & T3, respectively.

Judd et al. 1989
USA
Downs & Black score=13
Pre-Post
N=14

Population: Mean age=31.6y; M/F=9/5; Level of injury: paraplegia=7; tetraplegia=7; Depression status=clinically depressed evaluated using DSM-III
Treatment: Patients received supportive psychotherapy and were prescribed tetracylic and tricyclic antidepressants during rehabilitation period.
Outcome Measures: BDI

1. 13 of the 14 patients had improvement in BDI score at discharge (average BDI at discharge=8).
2. 1 patient required inpatient care in the psychiatric unit.

Judd et al. 1986
USA
Downs & Black score=11
Pre-Post
N=9

Population: Mean age=45.6y; M/F=8/1; Level of injury: tetraplegia=5; paraplegia=4. Depression status=clinically depressed evaluated using DSM-III.
Treatment: Patients were assessed within 2 weeks of admission and prescribed either mianserin or nomifensine along with supportive psychotherapy.
Outcome Measures: HDRS

1. All patients showed improvement in depressive and anxiety symptoms.
2. Anxiety symptoms improved within the first week while improvement in depressive symptoms did not occur until 3-6 weeks post treatment.
3. Side effects were minimal.