A Primary Care Provider’s Guide to Depression After Spinal Cord Injury: Is It Normal? Do We Treat It?

Although most people with spinal cord injury (SCI) are emotionally resilient, as a group they are at increased risk of major depressive disorder. Depression tends to be undertreated in people with SCI, perhaps because depression is mistakenly viewed as an expected reaction to severe disability or is confused with grief. Depression and grief are distinguishable, and the Patient Health Questionnaire-9 is a reliable and valid screen for major depression in this population. Major depression can be treated with antidepressants, especially venlafaxine XR, and with psychotherapy, especially cognitive behavioral therapy, focused on helping the person resume activities that were previously enjoyable or meaningful. Structured exercise also may help relieve depressed mood.