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Spinal cord injury (SCI) is a serious injury to the central nervous system, mostly from traffic injuries, fall injuries, violence or sports
.
Once the spinal cord is injured or necrotic, it is less likely to recover
.
The risk of psychiatric problems in patients with spinal cord injury is significantly higher than that of the general population; the guidelines suggest that all patients with spinal cord injury should be screened for major depression
.
Recently, the American Spinal Cord Injury Association (ASIA), a global authority in the field of spinal cord injury, released a new version of "Management of Mental Health Disorders, Substance Use Disorders, and Suicides in Adult Patients with Spinal Cord Injury: Clinical Practice Guidelines for Medical Workers", which aims to address 15 years ago The old version released is updated to reflect the research results in recent years and better guide clinical work
.
The full text of the guide has 73 pages
.
The following briefly introduces the drug treatment recommendations for patients with spinal cord injury associated with depression
.
Data show that patients with spinal cord injury and depression are more inclined to treat depression in rehabilitation institutions or other medical institutions, rather than being referred to a psychiatric specialist for antidepressant treatment
.
In addition, this group of patients seems to be more inclined to use antidepressants or individual psychological counseling, rather than accept group psychotherapy
.
In addition, active treatment of the current clinical conditions that may worsen depression in patients with spinal cord injury, such as the use of pregabalin to actively treat chronic neuropathic pain, and the treatment of hypothyroidism or obstructive sleep apnea, are all helpful in the use of antidepressants.
In addition to medicine, it can improve the patient's depression symptoms
.
A high-quality randomized double-blind placebo-controlled study of antidepressants showed that for a group of patients with spinal cord injury with an average duration of 11 years, a sustained-release formulation of venlafaxine (average dose of 186 mg/d) can significantly improve depression, anhedonia, since the crime, psychomotor retardation or agitation, anxiety and other mental
.
In addition, the sustained-release formulation of venlafaxine can significantly reduce the nociceptive pain of patients with spinal cord injury without increasing spasticity
.
Due to the lack of high-quality randomized controlled research evidence for other antidepressants, this guideline is currently difficult to provide evidence-based treatment procedures
.
However, based on knowledge from non-randomized controlled studies, guidelines and meta-analysis for other populations, the following recommendations for drug treatment for depression associated with spinal cord injury may be referred to ①In general, SSRI and SNRI may be The best tolerated antidepressant; however, for patients with spinal cord injury, the fluoxetine in the SSRI should be used with caution-case study data show that fluoxetine may increase the risk of spasticity in patients with spinal cord injury.
It is one of the most common complications of spinal cord injury
.
Given that information from other populations shows that SSRI and SNRI have similar efficacy, the prescription of antidepressants for patients with spinal cord injury should be based on side effects, drug interactions, previous treatment history, and patient preferences
.
②Patients with spinal cord injury often use multiple drugs at the same time.
The risk of QTc interval prolongation should be considered when choosing antidepressants, especially when citalopram is used in combination with other arrhythmogenic drugs
.
In addition to prolonging the QTc interval, patients with spinal cord injury also have the risk of 5-HT syndrome, exacerbation of spasticity, and agitation when combined with multiple drugs, especially when the patient is using indirect or direct sympathomimetic drugs
.
③Tricyclic antidepressants can not only cause drowsiness, but also have anticholinergic side effects, which can aggravate a series of symptoms related to spinal cord injury, including hypotension, constipation, and urinary retention.
Therefore, such drugs should be used with caution in spinal cord injury.
Patient
.
④Other antidepressants, such as bupropion, mirtazapine, vothiaxetine, verazodone, etc.
, have not been systematically studied in patients with spinal cord injury
.
⑤ When used in patients with spinal cord injury, the starting dose of antidepressants should be half of the conventional starting dose, and the rate of increase should also be half of the conventional rate of increase
.
⑥Although the initial dose is low and the increase rate is slow, in order to obtain the best effect, the target dose of antidepressants when used in patients with spinal cord injury and the duration of use of the dose (eg, 6-8 weeks) Patients with spinal cord injury are similar
.
⑦Efficacy and side effects monitoring should at least follow the requirements of the US Medical Service Effectiveness Data and Information Collection System (HEDIS), and may need to be more frequent, because patients with complex physical conditions are more likely to have adverse drug reactions
.
⑧ If the depression associated with spinal cord injury patients does not respond well to antidepressant treatment, consideration should be given to: 1.
Reassess the diagnosis; 2.
Switch to another antidepressant; 3.
Combine other drugs or psychotherapy; 4.
Electricity Shock treatment, or repeated transcranial magnetic stimulation (rTMS)
.
Literature Index: Bombardier CH, Azuero CB, Fann JR, Kautz DD, Richards JS, Sabharwal S.
Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury: Clinical Practice Guideline for Healthcare Cord Providers.
Top Spinal Cord Providers.
Inj Rehabil.
2021 Spring;27(2):152-224.
doi: 10.
46292/sci2702-152.
PMID: 34108836; PMCID: PMC8152173.
Click "Read Original" to view and retrieve historical articles
.
.
Once the spinal cord is injured or necrotic, it is less likely to recover
.
The risk of psychiatric problems in patients with spinal cord injury is significantly higher than that of the general population; the guidelines suggest that all patients with spinal cord injury should be screened for major depression
.
Recently, the American Spinal Cord Injury Association (ASIA), a global authority in the field of spinal cord injury, released a new version of "Management of Mental Health Disorders, Substance Use Disorders, and Suicides in Adult Patients with Spinal Cord Injury: Clinical Practice Guidelines for Medical Workers", which aims to address 15 years ago The old version released is updated to reflect the research results in recent years and better guide clinical work
.
The full text of the guide has 73 pages
.
The following briefly introduces the drug treatment recommendations for patients with spinal cord injury associated with depression
.
Data show that patients with spinal cord injury and depression are more inclined to treat depression in rehabilitation institutions or other medical institutions, rather than being referred to a psychiatric specialist for antidepressant treatment
.
In addition, this group of patients seems to be more inclined to use antidepressants or individual psychological counseling, rather than accept group psychotherapy
.
In addition, active treatment of the current clinical conditions that may worsen depression in patients with spinal cord injury, such as the use of pregabalin to actively treat chronic neuropathic pain, and the treatment of hypothyroidism or obstructive sleep apnea, are all helpful in the use of antidepressants.
In addition to medicine, it can improve the patient's depression symptoms
.
A high-quality randomized double-blind placebo-controlled study of antidepressants showed that for a group of patients with spinal cord injury with an average duration of 11 years, a sustained-release formulation of venlafaxine (average dose of 186 mg/d) can significantly improve depression, anhedonia, since the crime, psychomotor retardation or agitation, anxiety and other mental
.
In addition, the sustained-release formulation of venlafaxine can significantly reduce the nociceptive pain of patients with spinal cord injury without increasing spasticity
.
Due to the lack of high-quality randomized controlled research evidence for other antidepressants, this guideline is currently difficult to provide evidence-based treatment procedures
.
However, based on knowledge from non-randomized controlled studies, guidelines and meta-analysis for other populations, the following recommendations for drug treatment for depression associated with spinal cord injury may be referred to ①In general, SSRI and SNRI may be The best tolerated antidepressant; however, for patients with spinal cord injury, the fluoxetine in the SSRI should be used with caution-case study data show that fluoxetine may increase the risk of spasticity in patients with spinal cord injury.
It is one of the most common complications of spinal cord injury
.
Given that information from other populations shows that SSRI and SNRI have similar efficacy, the prescription of antidepressants for patients with spinal cord injury should be based on side effects, drug interactions, previous treatment history, and patient preferences
.
②Patients with spinal cord injury often use multiple drugs at the same time.
The risk of QTc interval prolongation should be considered when choosing antidepressants, especially when citalopram is used in combination with other arrhythmogenic drugs
.
In addition to prolonging the QTc interval, patients with spinal cord injury also have the risk of 5-HT syndrome, exacerbation of spasticity, and agitation when combined with multiple drugs, especially when the patient is using indirect or direct sympathomimetic drugs
.
③Tricyclic antidepressants can not only cause drowsiness, but also have anticholinergic side effects, which can aggravate a series of symptoms related to spinal cord injury, including hypotension, constipation, and urinary retention.
Therefore, such drugs should be used with caution in spinal cord injury.
Patient
.
④Other antidepressants, such as bupropion, mirtazapine, vothiaxetine, verazodone, etc.
, have not been systematically studied in patients with spinal cord injury
.
⑤ When used in patients with spinal cord injury, the starting dose of antidepressants should be half of the conventional starting dose, and the rate of increase should also be half of the conventional rate of increase
.
⑥Although the initial dose is low and the increase rate is slow, in order to obtain the best effect, the target dose of antidepressants when used in patients with spinal cord injury and the duration of use of the dose (eg, 6-8 weeks) Patients with spinal cord injury are similar
.
⑦Efficacy and side effects monitoring should at least follow the requirements of the US Medical Service Effectiveness Data and Information Collection System (HEDIS), and may need to be more frequent, because patients with complex physical conditions are more likely to have adverse drug reactions
.
⑧ If the depression associated with spinal cord injury patients does not respond well to antidepressant treatment, consideration should be given to: 1.
Reassess the diagnosis; 2.
Switch to another antidepressant; 3.
Combine other drugs or psychotherapy; 4.
Electricity Shock treatment, or repeated transcranial magnetic stimulation (rTMS)
.
Literature Index: Bombardier CH, Azuero CB, Fann JR, Kautz DD, Richards JS, Sabharwal S.
Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury: Clinical Practice Guideline for Healthcare Cord Providers.
Top Spinal Cord Providers.
Inj Rehabil.
2021 Spring;27(2):152-224.
doi: 10.
46292/sci2702-152.
PMID: 34108836; PMCID: PMC8152173.
Click "Read Original" to view and retrieve historical articles
.
