The Relationship Between PTSD and Depression

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A diagnosis of post-traumatic stress disorder (PTSD) and depression commonly co-occur. PTSD is characterized by symptoms of anxiety, flashbacks, and reliving traumatic experiences. The condition develops after a person experiences some sort of traumatic event such as a natural disaster, car accident, attack, abuse, or combat. On the other hand, depression is characterized by low mood, loss of interest and pleasure, and changes in energy levels.

Depression can also be a common response after a traumatic or stressful event, so it is perhaps not surprising that these two conditions can occur at the same time.

Research suggests that approximately 6.8% of all people will develop PTSD at some point in their lives. An estimated 7.1% of U.S. adults experience major depressive disorder in any given year.

Research has found that half of all people with PTSD also have a co-occurring major depressive disorder.

If you've received a dual diagnosis, here's why the conditions may be related.

Symptoms

Everyone feels sad from time to time, but depression is different from just feeling unhappy or sad. Depression is more intense, lasts longer, and has a large negative impact on your life.

These symptoms of depression and PTSD are described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Depression

  • Depressed mood 

  • Loss of interest or pleasure 

  • Weight loss or weight gain

  • Sleep difficulties 

  • Fatigue or restlessness

  • Feeling worthless and/or guilty

  • Difficulties concentrating

  • Thoughts of dying or suicide

PTSD

  • Unwanted memories

  • Flashbacks

  • Avoidance of trauma reminders

  • Feelings of isolation

  • Negative thoughts and emotions

  • Irritability

  • Hypervigilance

  • Exaggerated startle response

Diagnosis

According to the DSM-5, to be diagnosed with a major depressive episode, you must experience five of these symptoms within the same two-week period (or longer) and they must be a change from how you normally function.

In order to be diagnosed with PTSD, DSM-5 diagnostic criteria specify that a person must have experienced a traumatic event, must experience symptoms that include intrusive thoughts, avoidance, negative changes in cognition and mood, and changes in arousal and reactivity. These symptoms must be present for at least one month and must create significant distress or impairments in regular functioning.

How Often PTSD and Depression Coincide

Depression is one of the most commonly co-occurring diagnoses in people with post-traumatic stress disorder. In fact, researchers have found that among people who have (or have had) a diagnosis of PTSD, approximately 48% to 55% also experienced current or previous depression.

People who have had PTSD at some point in their lives are three to five times as likely as people without PTSD to also have depression.

How They Are Connected

PTSD and depression may be connected in a number of ways.

Increased Trauma

First, people with depression are more likely to have traumatic experiences than people without depression, which, in turn, may increase the likelihood that PTSD develops. A history of trauma and abuse is also a risk factor for depression, and those same traumatic experiences may also play a role in the onset of PTSD.

PTSD May Contribute to Depression

A second possibility is that the symptoms of PTSD can be so distressing and debilitating that they actually cause depression to develop. 

Some people with PTSD may feel detached or disconnected from friends and family. They may also find little pleasure in activities they once enjoyed.

Finally, they may even have difficulty experiencing positive emotions like joy and happiness. It's easy to see how experiencing these symptoms of PTSD may make someone feel very sad, lonely, and depressed.

Genetics May Play a Role

Another possibility is that there is some kind of genetic factor involved in the development of both PTSD and depression. Family history is known to be a major risk factor for the development of depression. Research has also suggested that there may be a genetic predisposition for PTSD. So it makes sense that genetics may also play a role in the co-occurrence of the two conditions.

Getting Treatment

If you have PTSD, it's important to seek treatment as soon as possible. The sooner you address your PTSD symptoms, the less likely it will be that they worsen and increase your risk for developing depression.

If you currently have PTSD and depression, it's also important to get treatment as soon as possible. Each disorder may make the other worse. Since PTSD and depression are commonly co-occurring mental disorders, 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 helpful in the treatment of PTSD and depression.

The presence of both conditions that can complicate the treatment process. However, there are treatment options that can be a good choice for treating both conditions at the same time.

Cognitive-behavioral therapy (CBT), in particular, is an empirically-supported treatment for both depression and PTSD. This approach involves identifying the negative cognitions that contribute to symptoms and then learning to replace these thoughts with more helpful responses.

Your doctor or psychiatrist will recommend treatment options that are best suited to your unique situation. This might involve the use of psychotherapy, such as CBT, as well as anti-anxiety or antidepressant medications. Self-help options such as lifestyle changes or online therapy can also be used to complement professional treatments.

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