The Relationship Between Post-Traumatic Stress Disorder (PTSD) and Depression

It is understood that Post Traumatic Stress Disorder (PTSD) and depression are often linked. This is supported by researchers who found that those who have been diagnosed with PTSD, roughly 48% to 55% have also experienced present or previous depression1)https://www.verywellmind.com/ptsd-and-depression-2797533 – accessed 16/10/2019, indicating a deeper understanding of the relationship is between the two conditions. Overall, depression is one of the leading co-occurring diagnoses in people with PTSD. 

A recent study published in Psychiatry Research2)Blakey, Shannon & Yi, Jennifer & Calhoun, Patrick & Beckham, Jean & Elbogen, Eric. (2019). Why do Trauma Survivors Become Depressed? Testing the Behavioral Model of Depression in a Nationally Representative Sample. Psychiatry Research. 272. 587-594. 10.1016/j.psychres.2018.12.150. was able to highlight reasons why traumatic experiences can often lead to depression. Evidence was found to show that when stress that was induced by trauma began to impede the survivors functioning in day to day activities it can predict the onset of depression.

Depression is the most commonly found mental health condition and affects around 1 in 10 people at some point in their lives. Research has found that people who have had PTSD are between three and five times as likely to also have depression, implying a strong correlation between the two conditions.

The DSM-5 describes the following symptoms of depression; low mood and/or tearfulness, apathy to previous interests and pleasures, a significant weight change, insomnia and difficulty sleeping, hypervigilance or fatigue, feelings of worthlessness or guilt, inability to concentrate, and thoughts of death and/or suicide. To be diagnosed with depression a person will have experienced five or more for two weeks or more and will not be able to “snap out of it” or feel positively about the future3)https://www.nhs.uk/conditions/clinical-depression/ – accessed 16/10/2019.  

Meanwhile, PTSD is a condition which relates to negative emotions such as shame, guilt, anger, and disgust, as well as impairments in the ability to effectively regulate these emotional states4)McLean, Carmen P., and Edna B. Foa. “Emotions and emotion regulation in posttraumatic stress disorder.” Current opinion in psychology 14 (2017): 72-77.. DSM-5 diagnostic criteria specifies 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, and these symptoms must significantly affect a person’s ability to function as they did before the event, or cause major distress5)National Collaborating Centre for Mental Health (UK. Post-traumatic stress disorder: The management of PTSD in adults and children in primary and secondary care. Gaskell, 2005.. While these emotions are normal responses to traumatic events, a person diagnosed with PTSD will experience these feelings persistently for over a month6) https://www.psychiatry.org/psychiatrists/practice/dsm/educational-resources/dsm-5-fact-sheets – Post Traumatic Stress Disorder – accessed 16/10/2019.

PTSD and depression have overlapping characteristics, these have been most commonly recognised as; 

Difficulty sleeping, either due to flashbacks in the form of intense nightmares, by which the person re-experiences traumatic events, or feeling like thoughts are on a continuous loop of negative thoughts, preventing a person from falling or staying asleep.

Losing interest in things that you used to enjoy, or take pride in. This can be seen in a person dressing differently, neglecting personal hygiene, withdrawing from hobbies, feeling an aversion to or apathy towards sex or food. 

Feeling irritable or short tempered. This can be due to feeling your mind is absent, or busy working through unprocessed trauma. It is common to feel that people are unable to understand you, or keep up with your line of thoughts, making it often frustrating to communicate with people who do not understand psychological conditions7)https://www.webmd.com/depression/depression-ptsd-vs-depression#2 – accessed 16/10/2019

Lastly, people who suffer from PTSD and/or depression can feel a desire to withdraw from relationships or social situations, preferring instead of the feeling of safety in solitude, often developing an emotional detachment from other people who once acted as islands of safety. 

According to Matthew Tull PTSD and depression are connected by the increase of exposure to trauma8) https://www.verywellmind.com/ptsd-and-depression-2797533 . Taking into consideration that those with depression are more susceptible to trauma, this alludes to an urgency to treat depression before it allows cumulative traumatic events, as a result of depression, to develop into PTSD. 

A dual diagnosis such as PTSD and depression require professional treatment, as each diagnosis can exacerbate the other if left untreated. Furthermore, if PTSD alone is left untreated, the risk of developing depression as a result is far higher. 

While there has been much research on the treatment of PTSD, no method has been shown to work for all those with the condition9) Brom, Danny, Yaffa Stokar, Cathy Lawi, Vered Nuriel‐Porat, Yuval Ziv, Karen Lerner, and Gina Ross. “Somatic experiencing for posttraumatic stress disorder: a randomized controlled outcome study.” Journal of traumatic stress 30, no. 3 (2017): 304-312.. This supports the argument that increasing the options for treatment beyond CBT/DBT means treatment is more widely accessible and effective. Previous research has shown that a “one size fits all” is ineffective for treatments of more complex psychological disorders. 

At Khiron Clinics, we are able to treat both PTSD and depression using holistic practices such as Somatic Experiencing, Structural Dissociation Therapy, Psychoeducation, fitness training, nutritional therapy, among many others. By processing traumatic memories in a safe and trauma informed environment, we are able to achieve symptom reduction and regulation.

The selection of these treatments are grounded by the International Society for the Study of Trauma (ISSTD) guidelines for the treatment of trauma10)http://www.isst-d.org/  – accessed 16/10/2019 and are delivered by some of the best treatment specialists in the UK, supported by leading national and international dignitaries in the sector. 

Khiron Clinic’s carefully constructed programme has been proven to reduce symptoms and stabilise dysregulated symptoms, such as those identified by the DSM-5 as the leading characteristics of PTSD and depression.

If you have a client, or know of someone who is struggling with PTSD, depression, or both concurrently, reach out to Khiron. We believe that we can stop the revolving door of treatment and misdiagnosis by providing effective residential and out-patient therapies for underlying psychological trauma. Allow us to help you find the path to effective, long lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

References   [ + ]

1. https://www.verywellmind.com/ptsd-and-depression-2797533 – accessed 16/10/2019
2. Blakey, Shannon & Yi, Jennifer & Calhoun, Patrick & Beckham, Jean & Elbogen, Eric. (2019). Why do Trauma Survivors Become Depressed? Testing the Behavioral Model of Depression in a Nationally Representative Sample. Psychiatry Research. 272. 587-594. 10.1016/j.psychres.2018.12.150.
3. https://www.nhs.uk/conditions/clinical-depression/ – accessed 16/10/2019
4. McLean, Carmen P., and Edna B. Foa. “Emotions and emotion regulation in posttraumatic stress disorder.” Current opinion in psychology 14 (2017): 72-77.
5. National Collaborating Centre for Mental Health (UK. Post-traumatic stress disorder: The management of PTSD in adults and children in primary and secondary care. Gaskell, 2005.
6.  https://www.psychiatry.org/psychiatrists/practice/dsm/educational-resources/dsm-5-fact-sheets – Post Traumatic Stress Disorder – accessed 16/10/2019
7. https://www.webmd.com/depression/depression-ptsd-vs-depression#2 – accessed 16/10/2019
8. https://www.verywellmind.com/ptsd-and-depression-2797533
9.  Brom, Danny, Yaffa Stokar, Cathy Lawi, Vered Nuriel‐Porat, Yuval Ziv, Karen Lerner, and Gina Ross. “Somatic experiencing for posttraumatic stress disorder: a randomized controlled outcome study.” Journal of traumatic stress 30, no. 3 (2017): 304-312.
10. http://www.isst-d.org/  – accessed 16/10/2019

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