Women with

  PTSD United

Depression is different from just feeling unhappy or sad. Depression is more intense, lasts longer, and has a large negative impact on a person's life. The following are the symptoms of depression (also called a major depressive episode) as described in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM IV):

  • Depressed mood for almost every day and for the majority of the day.
  • Loss of interest or pleasure in activities.
  • Considerable weight loss or weight gain.
  • Difficulties falling asleep or sleeping too much.
  • Feeling constantly on edge and restless or lethargic and "slowed down."
  • Feeling worthless and/or guilty.
  • Difficulties concentrating and/or making decisions.
  • Thoughts of ending one's own life. 


There are several forms of depressive disorders.

  • Major depression,—severe symptoms that interfere with your ability to work, sleep, study, eat, and enjoy life. An episode can occur only once in a person’s lifetime, but more often, a person has several episodes. According to the DSM-IV, to be diagnosed with a major depressive episode, a person must experience 5 of these symptoms all within the same 2-week (or longer) period.
  • Persistent depressive disorder—depressed mood that lasts for at least 2 years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for 2 years.


Some forms of depression are slightly different, or they may develop under unique circumstances. They include:

  • Psychotic depression, which occurs when a person has severe depression plus some form of psychosis, such as having disturbing false beliefs or a break with reality (delusions), or hearing or seeing upsetting things that others cannot hear or see (hallucinations).
  • Postpartum depression, which is much more serious than the "baby blues" that many women experience after giving birth, when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth.
  • Seasonal affective disorder (SAD), which is characterized by the onset of depression during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not get better with light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy.
  • Bipolar disorder, also called manic-depressive illness, is not as common as major depression or persistent depressive disorder. Bipolar disorder is characterized by cycling mood changes—from extreme highs (e.g., mania) to extreme lows (e.g., depression).


Depression is one of the most commonly occurring disorders in PTSD. In fact, it has been found that among people who have or have had a diagnosis of PTSD, approximately 48% also had current or past depression. People who have had PTSD at some point in their life are almost 7 times as likely as people without PTSD to also have depression. Another study found that 44.5% of people with PTSD one month after experiencing a traumatic event also had a diagnosis of depression.


How are PTSD and Depression Connected?
     PTSD and depression may be connected in a number of ways. First, people with depression have been found to be more likely to have traumatic experiences than people without depression, which, in turn, may increase the likelihood that PTSD develops.
     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 is easy to see how experiencing these symptoms of PTSD may make someone feel very sad, lonely, and depressed.
     A final possibility is that there is some kind of genetic factor that underlies the development of both PTSD and depression.

     Many symptoms of depression overlap with the symptoms of PTSD. For example, with both depression and PTSD, you may have trouble sleeping or keeping your mind focused. You may not feel pleasure or interest in things you used to enjoy. You may not want to be with other people as much. Both PTSD and depression may involve greater irritability. It is quite possible to have both depression and PTSD at the same time.


What Do I Do If I Think I Have Depression?

     The first step to getting appropriate treatment is to visit your doctor. Certain medications, and some medical conditions such as viruses or a thyroid disorder, can cause the same symptoms as depression. A doctor can rule out these possibilities by doing a physical exam, interview, and lab tests. If the doctor can find no medical condition that may be causing the depression, the next step is a psychological evaluation.
     The doctor may refer you to a mental health professional (Psychologist, Psychiatrist), who should discuss with you any family history of depression or other mental disorder, and get a complete history of your symptoms. You should discuss when your symptoms started, how long they have lasted, how severe they are, and whether they have occurred before and if so, how they were treated. The mental health professional may also ask if you are using alcohol or drugs, and if you are thinking about death or suicide. A plan for your treatment will then be determined.


Treatments
Once diagnosed, a person with depression can be treated in several ways. The most common treatments are medication and psychotherapy.
Medication:  Antidepressants primarily work on brain chemicals called neurotransmitters, especially serotonin and norepinephrine. Other antidepressants work on the neurotransmitter dopamine. Scientists have found that these particular chemicals are involved in regulating mood, but they are unsure of the exact ways that they work. The latest information on medications for treating depression is available on the
U.S. Food and Drug Administration (FDA) website .

Caution Regarding St. John's Wart! The extract from the herb St. John's wort (Hypericum perforatum) has been used for centuries in many folk and herbal remedies. Today in Europe, it is used extensively to treat mild to moderate depression. However, recent studies have found that St. John’s wort is no more effective than placebo in treating major or minor depression. In 2000, the FDA issued a Public Health Advisory letter stating that the herb may interfere with certain medications used to treat heart disease, depression, seizures, certain cancers, and those used to prevent organ transplant rejection. The herb also may interfere with the effectiveness of oral contraceptives. Consult with your doctor before taking any herbal supplement.

​​Psychotherapy
     Several types of psychotherapy—or "talk therapy"—can help people with depression.  Two main types of psychotherapies—cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT)—are effective in treating depression. CBT helps people with depression restructure negative thought patterns. Doing so helps people interpret their environment and interactions with others in a positive and realistic way. It may also help you recognize things that may be contributing to the depression and help you change behaviors that may be making the depression worse. IPT helps people understand and work through troubled relationships that may cause their depression or make it worse.
     For mild to moderate depression, psychotherapy may be the best option. However, for severe depression or for certain people, psychotherapy may not be enough. For example, for teens, a combination of medication and psychotherapy may be the most effective approach to treating major depression and reducing the chances of it coming back. Another study looking at depression treatment among older adults found that people who responded to initial treatment of medication and IPT were less likely to have recurring depression if they continued their combination treatment for at least 2 years.
Electroconvulsive therapy and other brain stimulation therapies
     For cases in which medication and/or psychotherapy does not help relieve a person's treatment-resistant depression, electroconvulsive therapy (ECT) may be useful. ECT, formerly known as "shock therapy," once had a bad reputation. But in recent years, it has greatly improved and can provide relief for people with severe depression who have not been able to feel better with other treatments.


Information Compiled from the following:

http://www.nimh.nih.gov/health/topics/depression/index.shtml

http://www.webmd.com/mental-health/tc/ptsd-and-depression-overview

​​http://www.ptsd.va.gov/public/problems/depression-and-trauma.asp


INformation, Resources, and Support for Women with PTSD