Depression Symptoms in PTSD vs. Treatment-Resistant D.

I've posted a version of the below in the new "treatment-resistant depression" forum, but for obvious reasons wanted to share it with this population as well. My apologies up front for any context that may be off-topic for this forum. Some of this will no doubt be of very little surprise to many here.

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I have complex PTSD, and had considered it to be comorbid with a couple of other things, including a current, follow-on episode of major depressive disorder which would be considered treatment-resistant based on the clinical definition or any other definition for that matter. I no longer consider this to be the case though.

It seems an obvious conclusion that some portion of people, myself among them, who are diagnosed with depression and even "treatment-resistant depression", simply have depressive symptoms that are part and parcel of PTSD/CPTSD, and not depression itself, and that it would be far better to regard them as such.

From what I read last night in this most recent PC article, Brain Scan Study Aims to One Day Personalize PTSD Treatment, I am now even more sure that it is wholly counter-productive, for me or anyone trying to treat me, to look at my depressive symptoms as being related to any depressive disorder, and therefore treat it as such. The study underlines that the better part of depressive symptoms in those with PTSD are likely and rather the result of what is ultimately physical injury, or as termed, psychiatric injury that is part and parcel of the disorder. Mainly I think it's counter-productive because of the nature of many psych professionals, in being so sure that the "right" anti-depressant or anti-depressant combination just has to be found, can result in a lot of lost time and in my case, a lot of lost hope where I had no sense of hope to begin with. Perhaps this belief on their part is understandable being that they have found it to be true in many cases of depression; but I've been aware for some time (and I've endured serious trauma since I was a young child) that anti-depressants simply do not work for me, based both on trial and error, and on my complete lack of response to them outside of a little tingling the first couple of times I try a new one.

I was struck by the article's description of kappa opioid receptors becoming retracted and largely inaccessible in PTSD, causing what is ultimately a physically induced dysphoria. While it's my belief that my earlier experiences with dysphoria, when I was a kid, may indeed have been related to major depressive episodes I'd had at the time, and they were overwhelming indeed, they were not so definite as the experience I'm having now. I feel shut down in a way that is very different now, and I haven't been able to quantify how that is but I've been overtly aware of it for some time. Perhaps at this point the number of receptors still exposed in my brain has lessened to an unfortunate tipping point. I don't know how they're going to coax them lil things back out of hiding, but I hope a solution is forthcoming soon, and is nothing too invasive. (sigh)

I especially hope that in future psych professionals will become more motivated and adept at discerning when depressive symptoms are resulting from PTSD, so that anti-depressant therapy is not so frequently misapplied. I personally feel that with as little mental and spiritual energy as I've had these last couple of years, the time, effort, and focus on therapy that simply didn't work has actually made me worse. That is to say, to have such a disheartening experience when so low on heart to begin with can be quite stressful in itself, and may have sent even more of my receptors into hiding. My former practitioner clearly interpreted my insistence that it wasn't working for me as resistance, when in reality any resistance I may have ever had to anything has been all but entirely diminished for some time now.

My former practitioner was also of the opinion that we needed to "treat the depression first" before trying to deal with anything else; but if what is presenting as depression in a case like mine needs to be treated as PTSD, the folly of that thinking is fairly obvious. Wheels spinning ad infinitum.

While I would not go as far as to assert that a depressive disorder could not be diagnosed as comorbid with PTSD, I think what has been found in this study makes it clear that screening for PTSD right up front, immediately, is essential, and that treating depressive symptoms in the traditional manner when any manner of PTSD is present should be a carefully considered option. Certainly insisting on repeated rounds of anti-depressants, and having an attitude towards a patient that they must be resisting, or non-compliant, or drawing some other such unhelpful conclusion, should be avoided by practitioners at all costs.

Well, a girl can dream anyway.

(((vonmoxie))), I hear what you are saying about how the depression that takes place with PTSD is different.

What I honestly feel is taking place with you is that you are/have been consistently triggered by the very environment dysfunction that hurt you to begin with and that has been presented to you by your mother.

I have a thread going about Clutter/overwhelm taking place in me and how I have not been able to reclaim my home as I had before. I talk about a room and wanting to finish it but I get very "depressed" and I actually avoid finishing it and it is very hard to explain what happens that I have been "avoiding it and don't know why that is taking place in my brain". However, I also feel this reaction physically too, like a cloak of depression comes over me without my even thinking about it.

I can't help remembering how you talked about how this problem got so much worse when you moved back home and to your home town too. Also how your mother's way of interacting with you is also zapping your strength as well. I have these challenges myself and yes, it can be debilitating at times, and very hard to understand and explain to others.

I do know it helps to talk about it, even understand it better, but I do not know if that alone is a cure. I have gained some ground, but it has been slow and I can't really say that I have "fixed" the problem "yet", I do know it is real and misunderstood by others.

I agree - not much will be achieved treating only depressive symptoms and leaving the PTSD untreated when PTSD is the root cause.

Complex PTSD has some good treatment guidelines on the Institutue of Traumatic Stress Studies (see link on my profile). Obviously, it does not include going straight into Prolonged Exposure.

Recent research in PTSD has included a lot of the Dissociative subtype (although obviously all PTSD has dissociative symptoms, such as flashbacks). The dissociation subtype is characterized in the DSM as involving derealization and depersonalization, and hopefully we will now see treatment tailored to this form of PTSD more often. Not all complex PTSD would be classed as Dissociative PTSD but much seems like it would be.

Ruth Lanius in particular has done excellent research on this, especially from 2012. Brain imaging showed different responses in the brain for this subtype, compared to "regular" PTSD.

I have to be honest, I am so frustrated right now. And I'm sorry it's negative. It's thoughts I've had for a long time, about being forsaken by the psychiatric industry, after having laid myself bare to it, opened my coffers wide, trusted in the process as it was insisted in almost a cult-like chanting manner that trust was my big issue, if only I would trust in the process and let it happen. I'm sick of being the collateral damage of an industry that would sooner ignore everything that could have helped me, than be accountable to its actions where its greasy handshake with big pharma and its 50% anti-depressant success rate is concerned. Where it's a hammer, I am not a nail and I never was. And I've been paying and paying and paying, with time and money I no longer have, for the privilege of coming very near to total ruin, and blamed for it.

And of course, for me, it's just one more betrayal. Trauma at the hands of those one chooses to trust implicitly is some of the most heinously delivered. I can tell you that unequivocally. Goes right to the heart, of which I had so very little left already.

I mean, it's great that I better understand now what's been happening (now that I'm doing all the work on my own that my former psych practitioners never did), but I'm just so depleted at this point. It shouldn't be this way.

How does a person who's been practicing psychiatry for what must be 30-40 years, treat me twice a week for a year, aware that among a wide array of traumatic life events I witnessed the rape of my own sibling by my own father at the tender age of 4, that my own father twice tried to kill me, managed to permanently disfigure me.. knows I was bullied in school by students and teachers alike, but bullied even worse at home, he's aware that besides finding myself suddenly without support, without my humanity in that the people who loved me and whom I loved, my best friend and my husband both suddenly gone from this earth.. he knows I'm isolating, that I'm in a constant state of panic, sees my thousand-yard stare.. how does he not consider PTSD and instead provide endless platitude-rich talk therapy and ineffective anti-depressants? How??

Am I angry? I hope so. I need the life energy.

Adding a trigger icon just because. My sad little reality is offensive to plenty, I've learned.

Wow, makes my experience look trivial - I only dealt with a quack for about 2 months.

(((((((((((((((((vonmoxie))))))))))))))))),

I am sorry you did not get the help you needed by people who are supposed to be professionals. I had to do a lot of research on my own too. Luckily, I do have a good therapist now, but I did go too long "without" the right help and support.

PTSD is still being studied, they don't really have all the answers yet, you are right, often the answer was "drug treatments" and people were put on several medications.

It is not unusual for a person to get diagnosed with Bipolar and GAD and a list of disorders when everything that is listed is all one thing PTSD.

I will say that a lot of the war veterans are using medical marijuana for their PTSD.

I am sorry that you have felt so betrayed, it's the last thing someone who is struggling needs.

((Gentle Caring Hugs))

OE

I had depression for quite a while before I developed PTSD as well as anxiety, I think those just set me up to be more vulnerable to PTSD. But it can be hard to separate what is the 'PTSD' and what has more to do with the ongoing depression and anxiety I had before since there is lots of overlap.

Also though past few therapists I've tried going to have even said they don't really know what to do with PTSD and attempt to just treat the depression and I get prescribed meds for anxiety(have tried meds for depression but none have worked and not currently taking any). But yeah it can be flustering because how can a therapist attempt to just treat the depression I can't very well choose between 'well which one do you want help with' its like well I need help with the whole package of mental health issues I have. So as a result even though I've been in therapy, my PTSD remains essentially un-treated still, was trying to be assessed for therapy directed at that with a different therapist but there was a mix up and I missed that appointment and have to reschedule. PTSD does a good job of screwing with concentration and remembering things and confusing me.

Seems like your dealing with a bit more crap than me, but I can sort of understand your frustration and face somewhat similar frustration, though I know in my case the depression came before the PTSD.

Wow!! I can totally relate to your frustrations and some of your experiences. I have been seeing a specific PTSD therapist for 6 months now and although it is very slow going it is getting better.

A few thoughts:

Donna Jackson Nakazawa's book "the last best cure" is a great read that includes some excellent information. Her next book will be coming out soon and i predict will be the handbook for all suffering with cptsd.

EMDR by Francine Shapiro explains about a trauma processing technique that helps victims reprocess traumatic memories in such a way that that cease being in the way of a person getting better - which is the issue with PTSD: it won't get better unless it is dealt with.

Having a quality PTSD therapist is essential. I have been having some success with EMDR, we were able to reprocess several traumas from my childhood so that they no longer flashback. When I remember them, it is not re-living them and the inappropriate emotions tagged to some of these things (it was my fault, I am dirty, I am not worthy of love, I am bad) have evolved into more realistic perspective- " it wasn't my fault, I was 4 and my parents should have gotten me medical treatment". I don't need to feel endlessly bad anymore for that memory.

Like you, I was really angry when I got the diagnosis and started reading about PTSD and thought about how much money and time I have lost being treated for depression/anxiety/sleep issues for 30 F#€<•ing years!!! No I find out that even my belly fat is probably related to the cptsd.

My inability to get a restful night sleep probably also stems from a life long issue of safety. If a parent hurts you or neglects you when you need them- you young life isn't safe. My brain is stuck in fight or flight so deep sleeping would make me vulnerable to attack so it doesn't go there. I had a sleep study in 1987, they said depression - if it was reviewed now by someone who was trained in PTSD- it would be flagged.

Many mental health providers aren't up to date on what PTSD outside of the military is, the signs, the seriousness, or the specialized treatment required. I was very lucky that my current Psychiatrist flagged it after 6 months of non responding and worsening symptoms (my brain shut down processing and my speaking was affected) post recent work place bullying/firing trauma. Also, luckily he was secure enough professionally to know that he wasn't qualified to treat PTSD. This probably saved my life.

Unfortunately, when I called my mental health insurance provider for a referral and told them that I needed someone specifically trained and experienced in PTSD because that was my diagnosis- the intake worker said "so you would like to talk to someone about that?" I wanted to scream at her!!! No, I want to be HEALED from that. The names that I got were a few social workers who had maybe a seminar and little experience. But for me, I was through with losing any more of my life- so I found the right person and am paying out of pocket. It is expensive but I am using my savings - I am no longer suicidal so that is priceless to me and my children. If I had taken my life, it would have left scars on my whole family. At the time, I couldn't see that, but now it keeps me motivated to keep working.

Overall, I wanted to tell you that I am sorry that you have had all of this- the trauma, the bad medical direction, the PTSD, all of it. But I would encourage you to take the energy you have a focus it on getting yourself better not seething on the things you can't change - on to the future!!

I was thinking about Vonmoxie the other day and wondered if I've missed her post. I haven't seen her around. Sad to see this was an old thread. I hope she's ok.

Thanks Parley, yes, I have noticed her absence as well and I really hope she is getting the help and support she needs. I don't like the "not knowing" at all and having no other way to check in on a fellow PTSD sufferer that I know could use the support.

I vaguely remember this thread, but I'm glad you brought it back up, Hoping2Smile, because you made some really good points in your comments.

I think so many of us have been misdiagnosed that it's almost laughable. Told we have X, Y, or Z, and treated for that with drugs and therapies that do diddly squat for us. Then we wonder "why can't it get better? Why isn't this working?" - and I think ultimately that leads to "it must be me, I must be the problem, I must not be trying hard enough" or whatever.