Amitriptyline in severely depressed spinal cord-injured patients: rapidity of response.

Nine severely depressed spinal cord-injured patients, six quadriplegic and three paraplegis, required psychiatric consultations and were treated with amitriptyline, with particular attention to the speed of response. The degree of depression was rated by using an Emergency Depression Rating Scale for Plegic Patients designed by one of the authors. All the study patients were initially rated as severely depressed, and within 72 hours their rating scores rose to the upper level of mild depression. These findings contrast with the accepted and widely reported phenomenon that in physically intact depressed patients, a positive response to tricyclic antidepressants is seen only after a 14- to 21-day interval. Several possible explanations of these findings are given, yet further in-depth explorations into the effects of tricyclic antidepressant medication on neurologically damaged patients are needed.