Editorial
Depression after spinal cord injury and medication: The journey continues Sigmund Hough Department of Psychiatry, Harvard Medical School, Boston, MA, USA Depression and pain can present significant challenges for an individual after spinal cord injury (SCI). The severity and chronic nature of the injury can easily transform these challenges into debilitating conditions that disrupts biopsychosocial functioning and decreases opportunities in life. When we speak of ‘quality of life,’ we inherently incorporate feeling good about oneself and one’s life, as well as being comfortable and safe within one’s environment. Venlafaxine extended-release (venlafaxine XR) medication has previously shown efficacy in the treatment of depression.1 However, there is a need to conduct controlled depression treatment trials for individuals with SCI. A randomized controlled trial, a gold standard for clinical trial research, has been completed.2 Across six SCI programs within the United States, 133 from 2536 screened individuals were enrolled into the trial. Between the ages of 18 and 64 years of age and a minimum of 1 month post SCI, subjects were given a 12-week trial of venlafaxine XR versus placebo utilizing a flexible titration schedule. Moving forward, the article highlights the importance of considering alternatives to randomly controlled trials, which address such drawbacks as half of the people not receiving active treatment. In addition, future efforts need to take on the challenge of treating depression and co-morbidities (for example, post-traumatic stress disorder, alcohol abuse, chronic pain, and unemployment) after SCI, which may require multi-modal interventions and analysis. The knowledge of methodological and operational system issues is critical as we transition academic thought into clinical trial research and eventually into evidence-based healthcare. Useful for planning the achievement of this goal is the understanding of decision
making within the system, staff training, human subject research process and approval, inclusion and exclusion criteria developed for selection, recruitment, and database development–maintenance–analysis. We know that medical and mental health services can help address depression, pain and anxiety. In fact, the combination of both approaches can be a powerful force to tackle even the most difficult clinical cases, as well as, address the debilitating impact that depression, anxiety, and pain can have on any person. The ownership of professional responsibility is to constantly review the efficacy of our methods, refine our tools, and conduct due diligence to maximize outcome for the individual receiving healthcare. Some researchers are satisfied in reporting positive outcome results. In A Randomized Control Trial of Venlafaxine XR for Major Depressive Disorder after Spinal Cord Injury: Methods and Lessons Learned, you have the outcome results and future research recommendations in terms of depression and pain for individuals with SCI. However, you have much more as the authors’ goal is to improve the way we investigate and not just report findings. The professional community appreciates the authors’ efforts to improve research and clinical healthcare on multiple levels. Thank you.
References 1 Wellington K, Perry CM. Venlafaxine extended-release: a review of its use in the management of major depression. CNS Drugs 2001; 15(8):643–69. 2 Bombardier CH, Fann JR, Wilson CW, Heinemann AW, Richards JS, Warren AM, et al. A randomized control trial of venlafaxine XR for major depressive disorder after spinal cord injury: methods and lessons learned. J Spinal Cord Med 2014;37(3):247–63.
Correspondence to: Sigmund Hough, Department of Psychiatry, Harvard Medical School, 396 Washington Street, Suite 211, Wellesley Hills, MA 02481, USA. Email: [email protected]
246
© The Academy of Spinal Cord Injury Professionals, Inc. 2014 DOI 10.1179/2045772314Y.0000000207
The Journal of Spinal Cord Medicine
2014
VOL.
37
NO.
3
Depression after spinal cord injury and medication: The journey continues Sigmund Hough Department of Psychiatry, Harvard Medical School, Boston, MA, USA Depression and pain can present significant challenges for an individual after spinal cord injury (SCI). The severity and chronic nature of the injury can easily transform these challenges into debilitating conditions that disrupts biopsychosocial functioning and decreases opportunities in life. When we speak of ‘quality of life,’ we inherently incorporate feeling good about oneself and one’s life, as well as being comfortable and safe within one’s environment. Venlafaxine extended-release (venlafaxine XR) medication has previously shown efficacy in the treatment of depression.1 However, there is a need to conduct controlled depression treatment trials for individuals with SCI. A randomized controlled trial, a gold standard for clinical trial research, has been completed.2 Across six SCI programs within the United States, 133 from 2536 screened individuals were enrolled into the trial. Between the ages of 18 and 64 years of age and a minimum of 1 month post SCI, subjects were given a 12-week trial of venlafaxine XR versus placebo utilizing a flexible titration schedule. Moving forward, the article highlights the importance of considering alternatives to randomly controlled trials, which address such drawbacks as half of the people not receiving active treatment. In addition, future efforts need to take on the challenge of treating depression and co-morbidities (for example, post-traumatic stress disorder, alcohol abuse, chronic pain, and unemployment) after SCI, which may require multi-modal interventions and analysis. The knowledge of methodological and operational system issues is critical as we transition academic thought into clinical trial research and eventually into evidence-based healthcare. Useful for planning the achievement of this goal is the understanding of decision
making within the system, staff training, human subject research process and approval, inclusion and exclusion criteria developed for selection, recruitment, and database development–maintenance–analysis. We know that medical and mental health services can help address depression, pain and anxiety. In fact, the combination of both approaches can be a powerful force to tackle even the most difficult clinical cases, as well as, address the debilitating impact that depression, anxiety, and pain can have on any person. The ownership of professional responsibility is to constantly review the efficacy of our methods, refine our tools, and conduct due diligence to maximize outcome for the individual receiving healthcare. Some researchers are satisfied in reporting positive outcome results. In A Randomized Control Trial of Venlafaxine XR for Major Depressive Disorder after Spinal Cord Injury: Methods and Lessons Learned, you have the outcome results and future research recommendations in terms of depression and pain for individuals with SCI. However, you have much more as the authors’ goal is to improve the way we investigate and not just report findings. The professional community appreciates the authors’ efforts to improve research and clinical healthcare on multiple levels. Thank you.
References 1 Wellington K, Perry CM. Venlafaxine extended-release: a review of its use in the management of major depression. CNS Drugs 2001; 15(8):643–69. 2 Bombardier CH, Fann JR, Wilson CW, Heinemann AW, Richards JS, Warren AM, et al. A randomized control trial of venlafaxine XR for major depressive disorder after spinal cord injury: methods and lessons learned. J Spinal Cord Med 2014;37(3):247–63.
Correspondence to: Sigmund Hough, Department of Psychiatry, Harvard Medical School, 396 Washington Street, Suite 211, Wellesley Hills, MA 02481, USA. Email: [email protected]
246
© The Academy of Spinal Cord Injury Professionals, Inc. 2014 DOI 10.1179/2045772314Y.0000000207
The Journal of Spinal Cord Medicine
2014
VOL.
37
NO.
3
