Treatment of major depression in individuals with spinal cord injury.

Objective: This study evaluated the effects of treating major depression in individuals with spinal cord injury (SCI), focusing on the degree of improvement and correlated changes that could be expected in 6 months of treatment.

Design: A pretreatment-posttreatment design was used. Random assignment to a nontreatment group could not be implemented ethically. Therefore, this study compared participants who declined treatment to persons who accepted treatment over a 24-month period.

Setting And Participants: Participants were outpatients of a large urban rehabilitation center in southern California. Twenty-eight participants who accepted treatment were assigned to a treatment group; 15 individuals who declined treatment were assigned to a nontreatment group. The age of the participants ranged from 20 to 74 years. Varying levels of SCI dysfunction were represented.

Interventions: A 6-month combination of psychotherapy and antidepressant medication.

Outcome Measures: A depression inventory, a community activities checklist, and a life satisfaction scale.

Results: A significant (P < 0.001) 57% reduction in depressive symptoms occurred in the treatment group, whereas there was no significant change in the nontreatment group. At the end of 6 months, 30% of participants had no depression, 42% had minor depression, and 29% still had major depression, but to a lesser degree. Community activities increased significantly over the treatment period, as did life satisfaction.

Conclusion: The results suggest that depression is treatable in this population, although 6 months may not be sufficient to reach maximum benefit in all cases. This study further identified obstacles that limited the ability to randomize participants into treatment arms and made it difficult to deliver services to all those in need. Complications related to SCI, such as difficulties in transportation, likely restrict the ability to implement needed services to many individuals with SCI.