Depression associated with physical disabilities

Depression is a serious illness that causes depressed mood, diminished participation in pleasurable activities, changes in weight, changes in sleep patterns, irritability, fatigue, problems with concentration, and a tendency toward suicide. The features of depression are not fundamentally different between physically able and physically disabled individuals; however, there is reason to believe that a positive correlation exists between depression associated with physical disabilities.

There is an unfortunate relationship between depression and physical disability. Even without physical disabilities, depression negatively affects physical functioning, which is intensified in those with limited physical abilities. Conversely, decreased physical activity is associated with increased risk for depression. In addition, the symptoms of depression are more severe in those who have physical disabilities.

Traditional treatments for depression

The two main treatments for unipolar depression or major depressive disorder are antidepressants and psychotherapy.

In fact, the combination of antidepressants and psychotherapy administered the same time outperforms treatment with only one or the other approach. 

Given their favorable safety profile (few side effects), the first choice for drug treatment are either selective serotonin reuptake inhibitors (SSRIs) or the newer serotonin noradrenaline reuptake inhibitors (SNRIs).

Cognitive behavioral therapy is based on the concept that our thoughts cause feelings and behaviors. Therefore, if people can be taught to change their thoughts, their feelings and behaviors will consequently change as well. Clinicians use highly structured educational techniques to encourage patient to question the validity and reality of inappropriate, harmful, or distorted thoughts.

Tailored treatments

While the approach to depression treatment is largely the same (medications and psychotherapy), clinicians must consider the specific needs of patients who lack full physical mobility. For example, even though SSRIs and SNRIs have good side effect profiles, certain drugs among them are known to cause weight gain. In people who have limited ability to exercise, drug-induced weight gain can lead rapidly to obesity and obesity-related diseases. 

Diarrhoea can be a greater problem for caregivers of those with physical limitations and, as such, certain medications will not be suitable.

Psychotherapy must also take into account the physical limitations of the patient. While cognitive behavioral therapy is probably the most efficacious psychotherapeutic method in the treatment of depression, physically disabled patients with depression do particularly well if they have adequate or excellent social support. Thus, family and group therapy may be useful in this regard. Support psychotherapy, i.e., psychotherapy aimed at improving self-esteem, psychological functioning, and adaptive skills, may be useful in addition to or instead of cognitive behavioral therapy.

Treating specific symptoms of depression

Sleep disturbances are common in depression. These include trouble falling asleep, trouble staying asleep, and waking from sleep too early. These difficulties can be amplified in people with disabilities, especially if there is limited physical activity during the day, if chronic pain is an issue, or in those who are visually impaired. Additional treatments, such as sleep aids, may need to be used to treat sleep disturbances.

Inadequate sleep can make depression worse, can impair quality of life, and can make people with physical disabilities more susceptible to injury and infection.

Suicide is extremely common in people with depression and the risk of suicide increases in those who also have physical illness, have chronic or inadequately treated pain, have a terminal illness, or feel socially isolated. Therefore, clinicians and caregivers should be particularly sensitive and vigilant for signs of suicidal behaviour.

Bright light therapy is not simply a treatment for seasonal affective disorder—it can be helpful in major depression. Bright light therapy has few side effects, if any, is well tolerated and is effective. This form of therapy can be administered in the home with few physical requirements.

Collaborative care programs focus on patient education and non-physician mental health professionals as the core treatment providers for depression. These programs are cost effective (which can be a significant concern for people with chronic physical disabilities). Collaborative care programs also improve symptoms, including suicidal ideation, physical functioning (tested in able-bodied patients), and quality of life.

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