Managing depression after spinal cord injury - Bard Care

Making positive lifestyle changes to manage depression after spinal cord injury


Low mood and depressive symptoms can occur frequently after spinal cord injury (SCI)1. There a myriad of reasons why, including loss of independence and function, as well as an altered self-image. It’s important to know that these are perfectly normal and common states of mind after suffering SCI, and that by adjusting your mindset and adopting healthy lifestyle measures, you can begin to make positive changes in the fight against depression. Depression is a serious medical condition that should be pursued by a qualified medical professional, but there are plenty of small changes you can make to your lifestyle to help manage moderate and mild depressive symptoms and low mood. In any case, the first step towards healing should you be feeling depressive symptoms, is actually recognising you have them.


Recognising depression

Depression has a tendency to creep up on people, so it is important to monitor your psyche and physiology so you can identify it timeously. Feelings of worthlessness and helplessness, and a loss of interest or pleasure in previously enjoyable activities are also common symptoms of depression, and you may find yourself withdrawing from social events and avoiding elements of your daily routine. Depression can also alter physiological behaviours, resulting in changes in sleep, appetite, and libido.2  Once you have recognised and alerted yourself to these symptoms, there are plenty of positive self-help activities and lifestyle changes that you can do to help manage them.


Small changes, big difference


Small changes can go a long way when managing depression, and making these changes should be a priority if you are experiencing any symptoms. Even if you feel ok, these depression busting strategies may make you feel even better — forming part of a healthy routine.


Get your heart pumping


Aside from the innumerable health benefits of exercise, a wave of feel good chemicals is released in response to physical activity. The way you exercise is likely to have changed dramatically since before the injury, but physical activity is still not only possible, but very necessary.3 Aim to make exercise a regular part of your life by devising an exercise plan with your physiotherapist or getting involved in wheelchair sports. Opt for exercise that you enjoy, and add an element of mindfulness to your physical activity by focusing on your breathing and your body during your session.

On the other hand it’s also easy to feel that you can’t exercise because of SCI, especially if your injury is severe. However, regarding this, we spoke to Gary Evans, a high level quadriplegic C4/5, who broke his neck playing rugby 28 years ago, about his SCI. He said,

“I'm paralysed from the shoulders down: I’m very limited. I’ve only got very slight movement in my right arm in the shoulder and a little bit in the bicep, but no useful movement in my left arm. So for me exercise is limited. It would just be about moving my right arm and shoulder. I don’t do any specific exercise really, but for a while I did go to physio, where they tried to get me to stand up, and they had access to a hydropool which was really helpful to me — I found it really relaxing and it helped exercise my right arm and shoulder”.

Gary showed that no matter the severity of your injury, you can still exercise in some capacity, and that it can help with a positive mindset. Unfortunately for Gary, his local council, who provided his physio, suffered budget cuts and scrapped it as a result. However, given the opportunity, Gary said he would gladly try physio again.


Boosting your mood through diet


Nutrition can also play an important role in your mood and overall wellbeing. Eating plenty of fruit and vegetables, for example, ensures that you have all the vitamins and minerals you need to keep your mind healthy4 .Omega 3 fatty acids found in oily fish, for instance, can also combat depressive symptoms5 — so making sure these form part of your diet can be really positive move for improving your lifestyle.

You should avoid highly processed foods though, such as trans fats, sugar, and refined carbohydrates. These can all disrupt your energy levels and influence your mood in a negative manner. Attempting to self-medicate with caffeine or alcohol is ill advised as well, and can often make the problem worse in the long-term.


Sleep yourself sane

Depression can often influence sleeping patterns, and people may sleep more or less than usual. Insufficient sleep adversely affects mood and health, but too much sleep can actually aggravate depression. So try to establish good sleeping habits and aim for eight hours a night. You can also try developing a wind-down routine before bed to help with this, such as not watching TV or playing on computer games for a certain amount of time before you sleep4


Shifting your focus


When negative thoughts pop up, analysing your thinking and shifting your perspective can be a really helpful influence on your mindset. 4 Watch that inner self-critic and any tendencies to label or overreact. If you feel a sense of hopelessness or worthlessness, examine the evidence — these feelings come from within you and more than likely are not based on actual reality. Focus on your accomplishments and the little joys throughout the day, and make a note of them. What are the
small things you are grateful for? This can be difficult, and sometimes it can feel as though you’re just living day-today. It can take time, but it’s so important to not let your thoughts turn negative — surrounding yourself with a strong support network is a very effective way to help with that.


Seek love and support


Leaning on your support system is such a powerful tool in fighting depression. It’s completely normal for depressed people to feel antisocial, but being lonely or isolated will only make things
worse. Gary, for example, said his accident happened whilst playing rugby when he was just 23 years old. He said that his rugby mates were there for him afterwards straight away, and that they would help take him out. His family was also another major influence in keeping his mindset positive:

“People accepting me for who I am was a big help. I have a very close family which I am very grateful for. I have a brother and sister who have kids of their own, and my nieces and nephews just all accept me for who I am. That was a big thing for me.”

Feelings of worthlessness and shame are common psychological problems that can be incredibly hard to shake should you be suffering from depression. But try reaching out to your partner, friends, and family. You may be surprised how many other people have experienced depression, and they may be able to offer you some valuable advice. Even if you don’t get to that stage, simply having someone to listen while you openly discuss your emotions is strongly encouraged.


Rediscover activities


Unfortunately, for people with depression, withdrawal from pleasurable activities at a time when they would be most beneficial is a common occurrence. Even if you don’t feel like it, participating in social activities and the things you used to find enjoyable can really boost your mindset. Rekindle old interests and hobbies, for example, or try and find new ones. Take it in as small steps as you need to: read a good book (or a few pages at a time), watch a funny movie, or listen to uplifting music. Reconnect with nature and spend a few minutes in the sun each day. If it doesn’t feel like fun at first, do it anyway. Gradually you will notice that you feel more upbeat, and your levels of interest will return.


Get professional help


Cognitive behavioral therapy and other psychotherapeutic techniques can also be very helpful in managing depression, particularly when it comes to training yourself on positive thinking and developing a positive attitude. In addition, certain people may require medical treatment in the form of antidepressants, so it's worth looking into if your depressive symptoms are particularly bad6, or if your GP suggests it’s a course of action you should consider.


If you feel you are suffering from depressive symptoms, and are struggling with staying positive, please give us a call, and we’ll put you through to one of our Bard nurses who will happily lend you their voice. Alternatively, you can look through our Learn section for more information. 


1 ArangoLasprilla, Juan Carlos et al. "Factors predicting depression among persons with spinal cord injury 1 to 5 years post injury." NeuroRehabilitation 29.1 (2011): 921.

2 Kapfhammer, H. "Somatic symptoms of depression." Dialogues in clinical neuroscience 8.2 (2006): 227.

3 Nash, M.S. Exercise as a Health‐Promoting Activity Following Spinal Cord Injury. Journal of Neurologic Physical Therapy, (2005) 29(2), pp.87103.

4 "5HTP: Uses, Side Effects, Interactions and Warnings WebMD." (2012). Accessed: 2 Jun. 2016

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5 Osher Y, Belmaker RH. Omega3 fatty acids in depression: a review of three studies. CNS Neurosci Ther. (2009) Summer; 15 (2) 1833

6 Mehta, Swati, and Jim Slivinski. "Depression Following Spinal Cord Injury.” (2014). Version 5.0: p135