Post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) are mental health issues that can be absolutely crippling for those affected. Things get even more complicated for the patient and the treatment plan when there is comorbidity between them, meaning both occur at the same time. Many of their symptoms can overlap, but these are two distinct mental disorders.
What Is PTSD?
PTSD is an anxiety disorder that is triggered by traumatic experiences such as:
- Childhood trauma
- Experiencing a natural disaster
- Sexual assault
- Being a victim of violent behavior
- Seeing someone else get hurt or killed
These traumatic experiences can produce PTSD symptoms that include:
- Bad dreams
- Flashbacks of the traumatic event
- Frightening thoughts
- Keeping physical distance from where the event occurred
- Mental distance (avoiding thoughts and feelings associated with the event)
- Difficulty sleeping
- Angry outbursts
- Being easily startled
- Feeling tense or “on edge”
What Is Major Depressive Disorder?
Everyone gets a little sad sometimes, but major depression is a debilitating mental illness that deeply affects functioning and quality of life. It’s a lot more than a depressed mood, which is why depression is currently ranked as the number one cause of disability worldwide by the World Health Organization. Major depression affects about 17 million Americans per year.
- Persistent sadness or depressed mood
- Loss of interest or pleasure
- Sleep disruptions (insomnia or sleeping too much)
- Changes in appetite (substantial weight loss or weight gain)
- Feeling worthless or guilty
- Slowed speech and movements
- Difficulty thinking, concentrating, or making decisions
- Thoughts of death or suicide
While PTSD is triggered following trauma, depression is more complex and involves biochemistry, genetics and environmental factors.
What’s the Connection Between PTSD and Depression?
There isn’t a one-size-fits-all way to classify PTSD and depression when they are co-occurring disorders. Many of the symptoms overlap, and there can be a bit of chicken–and –egg confusion over whether the PTSD is causing depression, or if depression made the PTSD worse following a traumatic event.
It is helpful to note that people with PTSD show a higher rate of comorbidity than other mental disorders. One clinical study stated, “ . . . [the question] is not whether PTSD is accompanied by another diagnosis, but which diagnoses are also present.” For example, nearly half of those affected by PTSD also have a substance abuse disorder. Along the same lines, they view the depression that stems from trauma as a possible “subtype” of PTSD. In other words, the trauma sparks off a type of PTSD that also triggers its own subset of depression symptoms.
Each individual case will be different, and it’s important to review your mental health history with a qualified professional. They’ll be able to determine which diagnosis is predominant and how to use that information to get you feeling better.
Is Treatment the Same for Depression and PTSD?
The treatment approach can look very different for major depression and PTSD. Each diagnosis has different courses of treatment that take specialization into account. When depression and PTSD occur together, it’s important for your mental health team to determine which to treat first. If depression symptoms like fatigue, poor concentration, sleep disruptions, and lack of appetite are too overwhelming to function, those will need to be lifted to work on processing the traumatic responses of your PTSD. If the PTSD symptoms are prominent, working on those should help lift any underlying depression.
This is where the “team” approach is truly important. A one-two punch of PTSD and depression can be tough to unravel, and likely requires a combination of both talk therapy and psychiatric treatment. When combining these approaches, it is an excellent idea to have your therapist and psychiatrist communicate in some way when you begin treatment. Their combined analysis will inform each side of your treatment plan and ensure your most critical symptoms are being addressed first.
How Is Depression Treated?
Because depression is such a common mental health diagnosis, treatments are well known and typically straightforward. Cognitive behavioral therapy (CBT) is often the first line of treatment, as it’s highly effective and doesn’t 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, they’re combined with talk therapy like CBT.
How Is PTSD Treated?
There are a number of antidepressants that are approved for treating PTSD. These medications have the added benefit of lifting your depression and anxiety symptoms.
The four prominently prescribed ones are:
- Sertraline (Zoloft®)
- Paroxetine (Paxil®)
- Fluoxetine (Prozac®)
- Venlafaxine (Effexor®)
Talk therapy treatment for PTSD is more complex and nuanced than what is typically used for anxiety and depression. It requires a much different approach, with types of therapy including:
- Prolonged exposure therapy
- Cognitive processing therapy
- EDMR (eye movement desensitization and reprocessing)
- Brief ecletic psychotherapy
- Narrative exposure therapy
- Written narrative exposure
Prolonged exposure therapy is considered the first line of talk therapy defense for PTSD. It’s a type of CBT that involves exposing the patient to difficult feelings or situations related to the initial trauma. By doing this in a careful way under a trained therapist, the patient learns to turn off the fear response when those triggers come up.
A New Option: TMS
There is an additional treatment option available that can replace or be used in conjunction with medication for both depression and PTSD: transcranial magnetic stimulation (TMS). The FDA has approved TMS to treat depression; it is not yet approved for PTSD and may not be covered by insurance.
The VA has started to use transcranial magnetic stimulation to treat PTSD in war veterans. The non-invasive treatment works by reconnecting neural pathways that become underactive in people with depression and PTSD. TMS has none of the side effects associated with antidepressant medications, and it’s highly effective. Psychiatrists such as those using it at the VA have seen great success with it. If you’ve tried medications and therapy but still have symptoms, TMS is a great option.
Non-veterans with PTSD can benefit from TMS treatment as well, for both PTSD and depression. Contact HPR Treatment Centers today to talk with our staff about your needs and get insurance pre-approval, if applicable.