Depression tends to be a “catch all” phrase that encompasses a variety of mood disorders and mental health conditions. It is a common condition that can affect anyone at any time. In general, it is estimated that about one in every 20 Americans experiences depression each year.

It’s even more common in people with spinal-cord injury (SCI). Estimates show 11–37% of people with SCI experience depression. It’s two to three times more likely in people with SCI than in the able-bodied population.

Depression affects people with SCI in many ways, including mood, ambition, outlook, and energy levels. It works against wellness, health and having a good quality of life.

People who are depressed generally stay away from other people and have little use for social situations. They isolate themselves and withdraw from interaction with others. Many studies report depression can be a fertile ground for substance abuse or drinking alcohol excessively.

We’re All Different

Although depression is common among people with SCI, many never experience a problem. For years, rehabilitation professionals believed depression after an injury was necessary for individuals to make a “successful adjustment.”

Today, we know depression is not necessary following SCI, and many people live successful and fulfilling lives without ever going through it. 

Over and over, studies have demonstrated that SCI does not predict behavior or mood changes for any individual. Every injury and every person is different. Behavior and emotion are a complex interaction of personality, environment and the nature of the injury.

In fact, the ability to cope with stress and the difficulties associated with SCI are often thought to be more related to the social supports of the individual rather than his or her unique personality makeup.

Although doctors are still not sure why people become depressed, we do know life stresses and medical conditions can cause a change in certain brain chemicals. These chemicals, called neurotransmitters, are linked to mood, sleep, enjoyment, energy level and sexual appetite.

Medications, counseling, or the combination of both can be effective in helping people cope with the emotional pain of depression.

Let There Be Light

Depression is not something that is only associated with a medical condition, but is often seen in many other forms. It can be a reaction to an event or time of year. Depression is often associated with the holiday season that extends from Thanksgiving to New Year’s Day. 

Holiday depression is often thought to be related to feelings of loneliness, separation from loved ones or memories of times that were more enjoyable and meaningful for the individual. Getting through the holidays can be especially difficult for senior citizens who may be more prone to loneliness.

These winter months also bring what is termed a “seasonal depression” to many people. The long stretches of darkness, isolation from others, and reduced activity at this time of year contribute to a general feeling of sadness, gloom and despair.

Although these feelings tend to diminish as the days get longer in the spring, winter can be an emotionally painful and difficult experience for many people who live in climates where cold weather prevails.

In response to seasonal depression, some studies have shown that exposure to light actually improves an individual’s mood. For this reason, some people purchase “light boxes” and spend hours exposed to bright lights. Other people find a vacation to a sunny climate improves mood and well-being. In general, seasonal depression does improve as the days get longer and people can begin to be more active.

Sad or Depressed?

While an emotional reaction to an event such as SCI is natural and expected, each individual’s response is unique. There are often similarities, however. Typically, feelings of sadness and loss are common for most people. In some cases, these emotional reactions can linger for long periods of time or can reoccur from time to time.

Although depression, grief, sadness, and bereavement may all seem similar, it is important to distinguish the differences. Sadness, grief, and bereavement are all disturbances of a person’s mood, but they tend not to have the prolonged and intense emotional pain that is noted with a depressive disorder. A clinical depression can be debilitating and life-threatening.

Medical and mental health professionals usually differentiate a depression from feelings of sadness by the symptoms that accompany depression. When depressed, people, regardless of injury or not, have disturbances of sleep, appetite, energy level, concentration, sexual interest, and mood. At this level, thoughts of death or a lack of interest in life can be frightening for the individual as well as his/her family.

Lift Your Spirits

If an individual is suffering from depression, it is important to seek medical care as soon as possible. Let your doctor know the symptoms you’re experiencing. With that information, he or she can help decide if medication or a referral to a mental health professional is needed.

Although depression can be  serious, there are a number of things you can do when feeling sad and blue:

 - Avoid isolating yourself. At these times, the natural reaction is to want to stay alone and avoid other people. In reality, doing this often makes the situation worse. Although you may not have the motivation, force yourself to be with other people as much as possible.

 - Share your feelings with other people. Most people find it difficult to talk about painful feelings and are fearful of being a burden to others. Let people around you know how you’re feeling and get emotional support from those close to you.

- Take care of yourself. When people are  feeling sad, they often just don’t care about sleep, eating, being active, taking medication or doing things that maintain their well-being. Although you may not be in the mood, force yourself to do what is best for your overall health.

 - Try an activity such as meditation, yoga, or relaxation exercises. To do this, put 15 minutes aside each day to sit quietly and clear your mind. Breathe deeply, relax the muscles in your body and quiet your mind from all thoughts. Enjoy the sense of peacefulness that can come from just being calm and quiet.

 - Remain active. Most of us are aware of how active we are during a typical day. Keeping this in mind, do things you would normally do and try to keep the routines that usually work well for you.

- Be cautious about alcohol use. Alcohol is a depressant and tends to increase feelings related to depression. Although initially a person may think he or she “feels better,” the longer-range effects will be to deepen feelings of sadness and depression.

 The winter months can be a difficult time for many people and when depression is more common. People with SCI may be more prone to depression because of difficulties with accessibility and being active.

Keep an eye on your general state of mind, mood, and attitudes. If your mood starts to head downward, be proactive. It’s easier to make positive changes if you notice the early signs.

Contact: ducharme@bu.edu.