Depression and adrenocortical function in spinal cord injury patients: a review

Depressive disorders are a significant problem among patients with spinal cord injury (SCI), but their diagnosis is difficult. The Dexamethasone Suppression Test (DST) has recently been shown useful for diagnosis of endogenous depression in physically healthy individuals. This article reviews the literature pertinent to depression and adrenocortical regulation after SCI, with special emphasis on DST. While depression is fairly common in SCI patients, endogenous depression occurs infrequently. The validity of the DST for diagnosis of depression in these patients is questionable because of the changes in adrenocortical regulation caused by SCI. Directions for future research are suggested.