What antidepressants are recommended for management of depression or anxiety in patients with spinal cord injuries?

Some general considerations first:

Acute or chronic injury? Associated TBI? Is uncomplicated depression/anxiety the main feature or significant anger and agitation? Is some cognitive rehabilitation needed? Is some motor system rehabilitation needed? On a vent? Difficult to wean?

Acute? Think about anticholinergics and hypotension. Chronic? Probably stable, medically. Think anticholinergics and urinary retention. TBI? Might want to emphasize cognitive rehabilitation.

Anger/agitation? I don’t want to increase it. Cognitive rehabilitation? Dopaminergic for processing and memory. Decreased motor functioning? Dopaminergic. On a vent/difficult to wean? Avoid sedation/respiratory depression.

In an uncomplicated case mirtazapine, citalopram or paroxetine are often helpful. For simple anxiety, hydroxyzine often helps.

For cognitive and motor system rehabilitation carbidopa/levodopa is often helpful. Weekly antidepressants can be paired with something more conventional for a synergistic benefit that can allow lower doses of both agents.

And finally, of course, you’re probably already dealing with polypharmacy and might be able to get some benefit by eliminating or reducing sedatives or depressants.