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One out of five people with SCI report problems with sleep, poor energy, low mood, loss of interest and appetite changes. These symptoms may result in part from stress-related changes in brain chemistry. Antidepressant medications such as venlafaxine XR (Effexor XR) are designed to rebalance brain chemistry and improve these basic biological functions. Despite widespread use of antidepressants, they have never been proven to be effective in people with SCI. This study examines the effect of venlafaxine XR on these symptoms and on pain in people who are at least one year post-SCI. Participants are randomized to receive a 12-week course of either venlafaxine XR or a placebo. Those who receive placebo and remain symptomatic at the end of the trial are offered free treatment with venlafaxine XR.