Prevalence, Indicators, and Innovative Treatment Options for Depression Post-Central Nervous System Injury

Depression is the leading cause of disability worldwide and the odds of depression are two to three times greater among those with physical disabilities. Accordingly, the prevalence of depression post-central nervous system (CNS) injury, such as post- stroke and spinal cord injury (SCI), is greater than the general population. The impact of depression extends beyond mood and motivation. Depression has been associated with adverse neuroplastic changes, diminished recovery, increased negative medical sequelae, and higher mortality. Unfortunately, depression is not easily treated. Antidepressants and psychotherapy often do not result in symptom remission and recurrent depressive episodes are common. Additionally, individuals post- stroke and SCI are at an increased risk of polypharmacy and adverse events with pharmacotherapy. Exercise has established anti-depressant benefits similar to pharmacological treatments and emerging evidence suggests properly designed programs can augment antidepressant treatments. Non-invasive brain stimulation, such as repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for depression in neurologically intact individuals, but its application post-CNS injury is limited. This thesis explores the following topics regarding depression post-CNS injury; (1) time to depression and associated risk factors post-SCI; (2) relationship between self-reported exercise and depression post-SCI; (3) use of rTMS and exercise post-stroke for treatment of depression

Economic and social changes among distressed family caregivers of lung cancer patients

PURPOSE: Although costs of lung cancer care have been documented, economic and social changes among lung cancer patients’ family caregivers have yet to be fully examined. In addition, research has not focused on caregivers with greater need for support services. This study examined various economic and social changes among distressed family caregivers of lung cancer patients during the initial months of cancer care in the United States. METHODS: Lung cancer patients’ primary family caregivers with significant anxiety or depressive symptoms were recruited from three medical centers within 12 weeks of the patient’s new oncology visit. Caregivers (N=83) reported demographic and medical information and caregiving burden at baseline. Seventy-four caregivers reported anxiety and depressive symptoms and economic and social changes three months later. RESULTS: Seventy-four percent of distressed caregivers experienced one or more adverse economic or social changes since the patient’s illness. Common changes included caregivers’ disengagement from most social and leisure activities (56%) and, among employed caregivers (n=49), reduced hours of work (45%). In 18% of cases, a family member quit work or made another major lifestyle change due to caregiving. Additionally, 28% of caregivers reported losing the main source of family income, and 18% reported losing most or all of the family savings. Loss of the main source of family income and disengagement from most social and leisure activities predicted greater caregiver distress. CONCLUSIONS: Findings suggest that distressed caregivers of lung cancer patients experience high rates of adverse economic and social changes that warrant clinical and research attention