Depression and Spinal Cord Injury

      Depression is common and can affect anyone. About 1 in 20 Americans gets depressed every year. Depression is even more common in the spinal cord injury (SCI) population—about 1 in 5 people.

      What is depression?

      Depression is not just “feeling blue” or “down in the dumps.” It is a serious medical disorder, just like diabetes, in which both biology and other factors can help or hurt. Depression is closely linked to your thoughts, feelings, physical health, and daily activities. Depression is not caused by personal weakness, laziness, or lack of willpower. Depression affects both men and women. Depression can cause some or all of the following physical and psychological symptoms:
      • Changes in sleep patterns (sleeping more or not being able to sleep)
      • Feeling down or hopeless
      • Loss of interest or pleasure in activities
      • Changes in eating habits (loss of appetite or overeating)
      • Diminished energy or activity
      • Difficulty concentrating or making decisions
      • Feelings of worthlessness or self-blame
      • Thoughts of death or suicide
      Periods of sadness are normal after SCI. However, there is cause for concern when feeling depressed or losing interest in your usual activities occurs almost daily and lasts for more than 2 weeks.

      What are the causes of depression?

      Although we do not know for sure what causes depression, we do know that life stresses and medical problems can cause a change in certain brain chemicals called “neurotransmitters.” This chemical imbalance is linked to depression. Not being involved in activities that are fun or rewarding, and being physically inactive are also risk factors.

      How is depression treated?

      The good news is that depression is treatable. Depression can improve with medications, counseling, or both. Regular exercise or physical activity can also improve mood, especially when used together with counseling or medications.
      It is important to treat depression because it can have such a harmful effect on a person's ability to function in day-to-day life. Depression can make pain worse, make sleep difficult, sap your energy, take away your enjoyment, make it difficult for you to take care of yourself, and lead to thoughts of suicide.

      How do antidepressants work?

      Antidepressant medications work by restoring a normal balance of brain chemicals such as norepinephrine and serotonin. Rebalancing these chemicals leads to feeling better emotionally and physically. Antidepressants are not addictive. Some people experience side effects, but they tend to lessen over time.

      What is counseling?

      There are many kinds of counseling or psychotherapy, but one type that has been proven to help depression is called “cognitive-behavioral therapy.”
      Cognitive-behavioral therapy is based on the idea that depression improves when people are more engaged in meaningful activities and when they regain their positive beliefs and attitudes about themselves and their future. The therapist helps you find or resume activities that are meaningful or enjoyable to you. The therapist also helps you recognize how your thinking becomes more negative in depression and how you can improve your outlook and rebuild confidence.

      What can you do?

      • 1.
      • 2.
        Answer all the questions honestly and see where your score falls.
      • 3.
        If your score is 10 or higher and you have been feeling this way for more than 1 or 2 weeks, contact your health care provider or a psychologist, psychiatrist, or counselor who has experience treating depression.
      • 4.
        If you are having thoughts of death or suicide, contact your health care provider or a mental health specialist immediately. Also, inform those around you about how bad you are feeling so they can support you and help keep you safe while you go through this difficult period.
      If you are in danger of harming yourself now, please call 911, the 24-hour National Crisis Hotline at 800-273-8255, or your local Crisis Clinic right away.

      How to find help

      Many mental health professionals are qualified to treat depression. For example, psychiatrists have specialized training in medication management for depression, and psychologists are trained to provide counseling for depression. Other physicians, such as primary care physicians, neurologists and physiatrists, and nurse practitioners with experience treating depression can often get treatment started and refer you to mental health professionals as needed. Seek treatment from a comprehensive SCI rehabilitation program that can address all aspects of SCI recovery.


      This information is not meant to replace the advice from a medical professional. You should consult your health care provider regarding specific medical concerns or treatment.


      Our health information content is based on research evidence whenever available and represents the consensus of expert opinion of the SCI Model System directors.


      Depression and Spinal Cord Injury was developed by Charles H. Bombardier, Ph.D., in collaboration with the University of Washington Model Systems Knowledge Translation Center and funded by NIDRR/U.S. D.O.E grant # H133A060070 . Copyright © 2010. May be reproduced and distributed freely with appropriate attribution.