With the Christmas holidays lying ahead, many of my SCI patients have said that this time of year has its own, immense challenges. As their able-bodied family and friends strip off and don their speedos/bikinis, hit the beach and enjoy the sun, the impact of spinal cord injury somehow seems magnifi ed. In these lonely times, when your injury is so much more in-your-face the risk of clinically significant depression may rear its head.
So how do you know if what you are feeling is depression (that could be effectively treated) or just plain gatvol? At the end of the day this is something that your doctor or a psychologist would need to discuss with you, but there are some useful pointers that you could look at for yourself. It is really important to remember that these are only pointers and may serve to confirm that a visit to your doctor is needed - they are not by any means a do-it-yourself diagnosis kit.
Good clinical research into depressive disorders in general, as well as depressive disorders in people with spinal cord injuries has shown that depression requiring medical treatment has a fairly typical footprint. To make it easy to recognise this footprint, it is useful to remember a simple mnemonic SIG: E CAPS:
The features or problems that may suggest that you have a depressive disorder are:
Sleep: The onset of a sustained change in your sleeping pattern - either with insomnia (an inability to sleep or sustain restful sleep) or hyper insomnia (excessive sleepiness).
Interest: A sustained loss of interest or an inability to find pleasure in activities that you have previously enjoyed. A tendency to neglect your self care and hygiene.
Guilt: Constant feelings of excessive guilt, worthlessness, hopelessness and helplessness.
Energy: Feelings of constant fatigue and loss of energy - and that just will not clear up and leaves you too exhausted to go out and do anything at all.
Concentration: Ongoing problems with a diminished ability to concentrate on normal tasks and activities combined with “paralysing indecision”.
Appetite: A sustained decrease or increase in your appetite - especially if this is accompanied by a weight gain or weight loss of more than five percent of your body weight.
Psychomotor: A sustained tendency to become very agitated, restless and a need to be constantly on the move - or in contrast a tendency to be slow and inert all the time.
Suicidality: Thinking about suicide or taking your own life - especially if you have considered and developed a planned to do this. Do you have access to the means to endure life? Have you ever previously attempted to take your life? Are you using or overusing alcohol or any other form of drug?
This is a useful list to keep in a diary on the bookshelf somewhat and to look through when times seemed dark and bleak.
While I know that many of my patients are happy, have adjusted to the overwhelming reality of their spinal cord injury and found new meaning and purpose, it is important never to find yourself stuck with your head in the sand.
Medical literature tells us that around 35% of people with spinal cord injuries develop severe depression at some time during the course of their lives. (In the able-bodied population this is closer to 10%). Spinal Cord Injury – and physical impairment in general – is a risk factor for depression!
Depression can be easily and effectively treated with medication and counselling. There may be other underlying factors that can also be improved and treated.
If you find that you have two or more of the SIG: E CAP: factors go and see your doctor or a psychologist and seek help. Depression need not leave you paralysed. Go and look for help!