The Influence Of Depression On Ptsd Treatment Outcomes
While the evidence is not universal, several studies have demonstrated that MDD influences PTSD treatment outcomes . In a sample of civilian survivors, Bryant et al. found that those who dropped out of CBT had higher levels of baseline depression than treatment completers. McDonagh et al. observed the same in a sample of childhood sexual abuse victims. Stein, Dickstein, Schuster, Litz, and Resick compared treatment response trajectories in participants allocated to cognitive processing therapy , CPT components, or prolonged exposure. Non-responders were more likely to have a diagnosis of MDD and report more severe baseline hyperarousal symptoms than non-responders. They concluded that those with comorbid MDD may need additional treatment.
Although the above findings suggest that MDD inhibits treatment efficacy, this has not always been observed, with some studies finding MDD to be unrelated to treatment response or dropout . For example, Gillespie et al. found that comorbidity was not associated with reduced treatment outcomes in PTSD sufferers. However, individuals with comorbid conditions received a greater number of treatment sessions. Further, Liverant, Suvak, Pineles, and Resick found that changes in PTSD and depressive symptoms during CPT and CPT treatment components occurred concurrently and that changes in one disorder did not influence changes in the other.
Evidence Supporting Ptsd/mdd Comorbidity As An Artifact Of Symptom Overlap
The diagnostic criteria for a major depressive episode have remained essentially constant across versions of the DSM from 1980 to 2013. There are 9 diagnostic criteria, and 5 must be present in order to meet diagnostic threshold. A DSM-III5 diagnosis required that 1 of the 9 criteria include depressed mood. In DSM-III-R6 and later versions,7–9 the criteria were revised such that the symptom of anhedonia could substitute for depressed mood. In contrast, the diagnostic criteria for PTSD have changed substantially over the same time period. Table I presents the symptom lists for the different versions of DSM. Note that the DSM-IIIR, DSM-W, and DSM-TV-TR versions are presented together in one column, as the criteria did not change appreciably across these three versions. The PTSD symptoms that overlap with MDD are presented in red text and include anhedonia, sleep disturbance, and concentration difficulties three symptoms that appear in the PTSD diagnosis across all versions of the DSM. The number of possible PTSD symptoms expanded from 12 in DSM-III to 20 in DSM-5. New symptoms that appear with iterations of the PTSD diagnosis are shown in blue text. The changes to the PTSD diagnosis in DSM-5 also brought forth a new symptom that overlaps between the two disorders, as guilt was added to the PTSD diagnostic criteria. Note that this symptom was present in the original diagnostic description of PTSD in DSM-III.
Major Depressive Disorder Post
The relationship between MDD and dementia has been discussed within the civilian literature for many years, according to Mahendra potentially back to the ninth century AD. A 2006 meta-analyses within the civilian population suggests that for those with a diagnosis of MDD there is an odds ratio of between 2.03 and 1.90 for dementia, depending on whether case control or cohort studies are examined . In addition to this, a recent review of the risk factors for dementia identified depression at any age, as well as late life depression, as two of the four core risk factors for dementia along with benzodiazepines use and frequency of social contact .
Potential pathways linking MDD/PTSD and dementia
Butters et al. and Greenberg et al. provide concise overviews of the potential pathways between MDD and PTSD with dementia. The following section will summarise the complimentary pathways discussed in these reviews, supplemented by evidence from the wider literature. It must be stressed that these are not the only potential pathways, but rather they represent a number of pathways commonly discussed in the literature. It is also worth highlighting that the pathways are not mutually exclusive.
Increased activation of the HPA
Increased cytokines and resultant inflammation
Increase in amyloid beta plaques
Potential unifying hypotheses
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Diagnosis Of Ptsd And Depression:
PTSD: PTSD can sometimes go unnoticed as it often overlaps with depression.
Depression: Depression is easily noticed and mostly treated for unlike PTSD.
1. PikiWiki Israel 36225 Soldier with ptsd By shiran golan Pikiwiki Israel , via Wikimedia Commons
2. Melancholy 2 by Andrew Mason via Wikimedia Commons
Getting Treatment For Ptsd And Treatment
If you have PTSD, which could include treatment-resistant depression, it is important to seek treatment as soon as possible. The sooner you address your PTSD symptoms, the less likely they will become worse and will in turn increase your risk for depression.
If you currently have PTSD and depression, it is still important to get treatment as soon as possible. Each disorder may make the other worse. PTSD and depression are very common co-occurring mental disorders. Therefore, mental health professionals trained in the treatment of PTSD are also usually well-trained in the treatment of depression. In addition, some treatments, such as behavioral activation, may be equally good in treating PTSD and depression.
IV Ketamine Infusion Therapy could be an effective treatment of your PTSD depression with very good success in ongoing trials.
Breslau, N. . Epidemiologic studies of trauma, posttraumatic stress disorder, and other psychiatric disorders. Canadian Journal of Psychiatry, 47, 923-929.
Breslau, N., Davis, G.C., Peterson, E.L., & Schultz, L. . Psychiatric sequelae of posttraumatic stress disorder in women. Archives of General Psychiatry, 54, 81-87.
Jakupcak, M., Roberts, L.J., Martell, C., Mulick, P., Michael, S., Reed, R. et al. . A pilot study of behavioral activation for veterans with posttraumatic stress disorder. Journal of Traumatic Stress, 19, 387-391.
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Secondary Service Connection Depression
Its also possible for veterans to receive disability benefits based on secondary service connection. This could be that their depression stems from another service-connected medical condition thus it is compensable. Depression could also be considered the primary service-connected condition that leads to another disability that can be secondarily connected.
Below, lets get into common secondary conditions with depression.
For example, a veteran may have back pain that impairs their ability to work, socialize with friends and family members, and complete daily activities. These limitations may lead to depression.
In order to receive benefits based on secondary service connection, a veteran must receive a diagnosis from a medical professional. A medical professional must also provide evidence of the link between the veterans service-connected injury or illness and the depression.
Pathways To Comorbid Ptsd/mdd
Research examining the temporal order of PTSD and MDD development has suggested several potential pathways to PTSD/MDD comorbidity. Some researchers have proposed that pre-existing MDD may elevate one’s susceptibility to traumatic events . Others suggest that MDD may be a reaction to PTSD, whereby PTSD is a risk factor for the development of MDD . Recently, Stander, Thomsen, and Highfill-McRoy examined the literature regarding the development of comorbid PTSD/MDD in military samples. Although the reviewed literature generally supported the hypothesis that PTSD was a causal risk factor for the development of MDD, they acknowledged that the exact relationship between PTSD and MDD was likely to be complex, involving bidirectional causality, common risk factors, and common vulnerabilities.
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Trauma Focused Therapy For Comorbid Ptsd/mdd
The effects of trauma-focused CBT are not confined to PTSD symptoms, with trauma-focused therapy consistently producing significant reductions in depressive symptoms . For instance, Resick et al. found that at pretreatment, 51% of treatment completers had an MDD diagnosis, whereas 16% continued to meet the diagnosis at post-treatment and only 13% at the 6-month follow-up. However, the question still remains as to whether a single focus on PTSD is the most effective means of treating comorbid PTSD/MDD. Although no study to date has explored whether a single focus on PTSD is superior to a treatment program that also focuses on MDD, this has been examined in non-PTSD comorbidities , and findings suggest that treatments focused on principal diagnoses may reduce comorbidity severity.
Trauma-focused therapy may have positive effects on comorbidity for numerous reasons. For instance, individuals may apply core CBT strategies to comorbid symptoms, or such treatments may target and improve emotion processes that are shared across emotional disorders . Further, trauma-focused CBT may be effective in reducing MDD symptoms as the treatment shares much in common with typical MDD treatments. For instance, CPT and cognitive therapy both target maladaptive cognitions.
Symptoms Of Ptsd And Depression
Its possible to experience some of the same symptoms from one subgroup of PTSD that relate to changes in mood and thoughts overlapping with those from depression.
With both disorders, you may:
- Lose interest in activities you previously liked
- Feel hopeless
- Have negative feelings or pessimism
- Have cognitive impairments such as trouble concentrating or remembering
Other symptoms of the two disorders are similar. For example, PTSD may cause a lack of joy, passion and feeling useful, while depression can cause a person to lose their sense of worth, have a depressed mood and feel helpless.
While the two disorders have some of the same and similar symptoms, they are unique disorders with some distinct symptoms and characteristics. Its important to be assessed and diagnosed to get proper and effective treatment for each disorder.
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Triggers Of Complex Ptsd
People who have PTSD or complex PTSD can react to different life situations as if they are reliving their trauma.
The particular situation that triggers a person can be random and varies depending on their specific trauma history. A person can be triggered by situations, images, smells, conversations with others, and more.
This triggering can manifest as a fight-or-flight response triggered by the amygdala, responsible for processing emotions in the brain.
When this happens, a persons brain can perceive that they are in danger, even if they are not. This is known as an amygdala hijack and can also result in things like flashbacks, nightmares, or being easily startled.
People with PTSD or complex PTSD may exhibit certain behaviors in an attempt to manage their symptoms.
Examples of such behaviors include:
- misusing alcohol or drugs
- avoiding unpleasant situations by becoming people-pleasers
- lashing out at minor criticisms
These behaviors can develop as a way to deal with or try to forget about the original trauma and the resulting symptoms in the present.
Friends and family of people with complex PTSD should be aware that these behaviors may represent coping mechanisms and attempts to gain control over emotions.
To recover from PTSD or complex PTSD, a person can seek treatment and learn to replace these behaviors with ones focused on healing and self-care.
Other examples of trauma that can cause complex PTSD include:
Depression And Heart Conditions
As Ive written above, stress, seasonal affective disorder, substance use disorders, bipolar disorder, social isolation, and diabetes secondary to primary depression can lead to cardiovascular problems. However, depression alone is the biggest culprit. Depression alone predicts the development of coronary heart disease in initially healthy people.
As if all this wasnt bad enough, when those who suffer from depression DO have a heart attack, they are more than three times more likely to die within 18 months than those without depression.
Depression Aggravated by Service
There are some cases where a veteran who has been diagnosed with depression before service may have an event in service that causes their mental illness to worsen, or be aggravated. Service connection is still possible.
There are some cases where a veteran may have been living with depression before their time in service. This individual may have had an experience during military service that caused their mental illness to worsen. This is called aggravated service connection an event in service that made a pre-existing condition worse.
Aggravated service connection for a pre-existing diagnosis of depression requires:
- A current diagnosis of depression by a VA doctor, psychiatrist, or psychologist
- Evidence of an incident in service that worsened the depression
- Medical evidence of a link between the worsening of the depression and the incident in service.
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Is Complex Ptsd A Separate Condition
ICD-11 complex PTSD as a separate condition, though the DSM-5 currently does not. Some mental health professionals are beginning to distinguish between the two conditions, despite the lack of guidance from the DSM-5.
Research has also supported the validity of a separate diagnosis of complex PTSD. At least 29 studies from more than 15 countries have consistently shown the differences in symptoms between traditional PTSD and its complex variation.
One 2016 study that included more than 1,700 participating mental health professionals from 76 countries showed that clinicians could differentiate between the two diagnoses.
A person with complex PTSD may experience symptoms in addition to those that characterize PTSD.
Common symptoms of PTSD and complex PTSD include:
- avoiding situations that remind a person of the trauma
- dizziness or nausea when remembering the trauma
- hyperarousal, which means being in a continual state of high alert
- the belief that the world is a dangerous place
- a loss of trust in the self or others
- report complete amnesia of the trauma.
- Preoccupation with an abuser: It is not uncommon to fixate on the abuser, the relationship with the abuser, or getting revenge for the abuse.
Symptoms of complex PTSD can vary, and they may change over time. People with the condition may also experience symptoms other than the above.
Depression And Maladaptive Cognitive Processes
As noted, depressive rumination may also influence treatment outcomes in those with comorbid PTSD/MDD. Some models of depression conceptualise rumination as a problematic escape behaviour that is not dissimilar to overt forms of avoidance . The behavioural activation model explicitly acknowledges the role of rumination, and while it suggests that rumination is distinct from other more obvious forms of avoidance , it posits that the function is the same. That is, that rumination operates to actively avoid engagement with the environment. In line with such a conceptualisation, Moulds, Kandris, Starr, and Wong found rumination, avoidance and depression to be significantly correlated in a non-clinical sample. Further, rumination and behavioural avoidance remained related when anxiety was controlled. By conceptualising rumination as an active form of avoidance, rumination is likely to inhibit the processing and elicitation of trauma memories and emotions, and depressed individuals with a ruminative response style are likely to underengage during PTSD treatment and show poorer outcomes.
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Evidence Supporting Ptsd/mdd Comorbidity As A Distinct Trauma
An alternative view is that the comorbidity between PTSD and MDD represents a distinct phenotype, possibly even a subtype of PTSD. As discussed below, evidence to support this view can be inferred from the research literature examining risk factors and biological correlates of the two conditions. With respect to the phenomenology of the comorbidity, people with both PTSD and MDD report higher levels of distress and role impairment.19–21 They also show higher impairment in neurocognitive functioning22 and are at greater risk for suicide20,23 than people with PTSD only. Moreover, prognosis for people with both conditions is poorer than for either one alone.24 Finally, there are distinct biological profiles associated with PTSD versus MDD, as reviewed below.
Where To Find Help
here to help now
You are not alone. Help may be one phone call or text away. If you feel suicidal, alone, or overwhelmed, call 911 or contact one of these 24-hour hotlines:
- US Veterans Crisis Line: Call 1-800-273-8255 and Press 1, or text 838255
- Crisis Text Line: Text CONNECT to 741741
If you believe you have either PTSD or depression, make an appointment to see a healthcare provider. They can recommend or refer you to a mental health specialist for evaluation and treatment.
If youre a veteran and need help, call the Veteran Center Call Center hotline at 1-877-927-8387. At this number, youll get to talk with another combat veteran. Family members can also speak to other family members of vets with PTSD and depression.
find a counselor in your area
- United Way Helpline : Call 1-800-233-4357
- Mental Health America : Call 800-237-TALK or text MHA to 741741
If you dont have a doctor or mental health specialist you see regularly in your area, call your local hospitals patient outreach office.
They can help you find a doctor or provider near you that treats the conditions youre seeking to cover.
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What Drugs Are Used To Treat Post Traumatic Stress Disorder
drowsiness Nausea Insomnia diarrhea nervous agitation Dizziness Headache Changes in sexual function
How serious is post traumatic stress disorder?
Symptoms can worsen and mental health can decline. The affected person can become harmful to themselves or others. If treatments with counseling and medical therapy are used, signs and symptoms can be alleviated.
What are the 17 symptoms of PTSD?
Intense feelings of distress when reminded of a tragic event
How Is Depression Treated
Because depression is such a common mental health diagnosis, treatments are well known and typically straightforward. Cognitive-behavioral therapy is often the first line of treatment, as its highly effective and doesnt require starting medication. In fact, studies show it can be just as effective as antidepressant medication. CBT is a talk therapy that works by having the patient discuss and write down negative thought patterns, so they can be properly analyzed and reframed.
Antidepressant medications such as SSRIs and SNRIs are often prescribed for depressive symptoms. Often, theyre combined with talk therapy like CBT.
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