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While there are few randomized controlled studies that look at interventions to treat moderate to severe depression in people with spinal cord injury (SCI), a new study in the Archives of Physical Medicine & Rehabilitation found that therapies delivered online and the antidepressant venlafaxine XR appear promising.
People with SCI are almost three times as likely to experience moderate depression (23%) compared to the general population (8%). But detection of mental health problems in people with SCI is only 10%.
“Rehabilitation clinicians need guidance regarding effective treatments for people with spinal cord injuries who experience depressive symptoms,” says Allen Heinemann, PhD, Director of the Center for Rehabilitation Outcomes Research at Shirley Ryan AbilityLab and senior author on the study.
Heinemann and colleagues conducted a systematic review of literature focusing on the treatment of depression in people with SCI. They looked for studies (2013-2023) that compared the efficacy of behavioral, pharmacological, complementary and alternative medicines to a control group in people with SCI 18 years old or older with moderate to severe depression. Studies needed to establish a minimum cutoff score on a validated screener or inventory for major depressive disorder that correlated with at least moderate clinical depression to be included.
Database searches generated 2,780 unique studies. The researchers excluded 2,697 based on title and abstract leaving 83 studies for full-text review. Only eight studies met eligibility criteria for the systematic review.
“There's not enough rigorous research into interventions for depression in patients living with spinal cord injury,” says Robert Cotter, a medical student at Yale and first author of the study. “There are many studies that evaluate interventions for depressive symptoms in this population, but there aren’t a lot of studies in patients with SCI that require a diagnosis of clinical major depressive disorder or at least clinically relevant cutoff scores on validated measures of depressive symptoms for inclusion. We only found eight such studies in our search, so one key takeaway is that there needs to be more rigorous research into interventions for depression in people with SCI.”
Six of the eight studies were randomized controlled trials, and the two remaining studies were a quasi-randomized controlled trial and a cohort study. Six studies evaluated therapy-based interventions, including telehealth support, cognitive behavioral therapy, group therapy, hyperbaric oxygen therapy and a self-administered online course. One study evaluated a pharmacological intervention (venlafaxine XR) and one looked at Eye Movement Desensitization and Reprocessing (EMDR), a mental health treatment technique to manage traumatic and distressing experiences.
The researchers found that both individual- and group-delivered interventions and venlafaxine XR were effective in reducing depressive symptoms in people with SCI, and online delivery of therapy enhanced engagement and accessibility. Venlafaxine XR and individually-delivered cognitive behavioral therapies and mindfulness training appeared most promising and are best supported among the studies, but “much more research is needed before more concrete recommendations for clinical practice can be made,” says Cotter.
Jennifer Burns, Katherine Kaufman, Angelika Kudla, Linda Ehrlich-Jones, PhD, RN, at the Center for Rehabilitation Outcomes Research at Shirley Ryan AbilityLab and Q. Eileen Wafford, at the Northwestern University Feinberg School of Medicine, are co-authors on the paper.
This research was funded by grant 724833 from the Craig H. Neilsen Foundation.
