Depression is a major cause of morbidity worldwide. One of the risk factors that is associated with the development of this illness and its increased clinical severity is exposure to early traumatic events.
Standardized clinical classifications such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification Disease (ICD) have postulated a single unipolar depression. Nevertheless, there is clinical and neurobiological evidence that suggests a distinguishable subtype of depression as a function of childhood trauma that ought to require specialized treatments. In this article, we shall discuss trauma and depression: an overview.
Most of the approaches related to trauma have considered Posttraumatic stress disorder (PTSD) as the main diagnosis. However, depression is two times more prevalent than PTSD in the general population. Even though both pathologies are very often present in comorbidity, the study of depression as a result of trauma exposure is scarce. This area needs more attention, not only in trauma research but also in public mental health policies.
Surviving trauma is challenging enough — and it can also affect your mental health long after the trauma itself has happened.
Types of trauma vary widely, from public traumatic events, like terrorism, to more personal traumatic experiences, like sexual abuse. No matter the specific experience, all trauma can shake you to your core.
Depression can be both a direct and indirect consequence of trauma. However, not all depression is caused by trauma — other factors that cause depression include genetics, environment, and other medical conditions.
Facing trauma and depression at once can be overwhelming. However, many people live happy and fulfilled lives with trauma treatment and the support of others.
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Can trauma lead to depression?
In short, yes. Depression is a common response following a traumatic event.
In fact, a 2013 research review by Trusted Source suggested that 52% (more than half) of the participants with post-traumatic stress disorder (PTSD) also had a major depressive disorder.
What’s more, a 2015 study found a clear link between childhood trauma and depressive symptoms later in life. This study found that, out of 349 people with chronic depression, 75.6%Trusted Sources reported experiencing trauma in childhood. Furthermore, people with a history of multiple traumatic events had an increased severity of depressive symptoms.
Depression is more than just feeling down or blue. The symptoms of depression can include:
- lack of energy
- lack of interest and pleasure in activities you used to enjoy
- significant weight loss or gain
- excessive sleeping or insomnia
- excessive guilt
- inability to concentrate
- feelings of worthlessness
- recurrent thoughts of death or suicide
Note that not everyone who experiences a traumatic event will develop depression or PTSD.
Depression and the nervous system
Traumatic experiences can have a significant impact on your brain and nervous system even if you aren’t diagnosed with depression later.
This emotional response to trauma can have a significant impact on your neurological (brain) and physiological (body) functions. It may affect your brain chemicals and nervous system.
When faced with intense emotional stress or an unsafe situation, the body naturally engages the fight-or-flight system to help you escape from the threat.
However, if you can’t escape the situation, the body engages in the freeze response. Here, the nervous system shuts down, or freezes, as a way to protect yourself, like a gazelle “playing dead” when it can’t get away from a predator.
According to the polyvagal theoryTrusted Source, if your body enters the freeze response, it’s known as entering dorsal vagal shutdown. That’s because this shutdown state is controlled by a part of the nervous system called the dorsal vagus nerve.
When your body enters this dorsal vagal “freeze” state, you may experience symptoms of depression, such as feeling numb, disconnected, fatigued, and slow. Triggers from previous traumas may lead your body to enter this state long after the trauma itself has ended.
What does the freeze state look like?
When facing extreme stress, our bodies can go into survival mode and react with the following defense mechanisms that have parallels with the symptoms of depression:
- out-of-body experiences or dissociation
- a disconnect from your environment
- feeling numb
- spacing out, or your eyes becoming fixed
- a drop in heart rate and blood pressure
- flat effect or your facial expressions becoming flat
- slowed breathing
- feeling nauseous, vomiting, defecating, or urinating
- a lump in the throat, or feeling unable to speak
- an inability to think clearly
- feelings of your body collapsing or curling into a ball
Depression vs. PTSD
Depression and PTSD are different conditions, but they commonly occur together. The National Center for PTSD reports that depression is almost 3 to 5 times more likely in people who have PTSD.
There is some overlap between depression and PTSD. The two conditions share the following symptoms:
- difficulty concentrating
- loss of pleasure in activities you used to enjoy
On the other hand, PTSD differs from depression with these signs:
- reliving the traumatic event, such as intrusive memories, nightmares, flashbacks, or being triggered
- avoiding situations that remind you of the traumatic event
- increase in negative thoughts about yourself that weren’t there before the traumatic event
- a tendency of being on high alert, jittery, and continuously looking for danger, known as hypervigilance
Managing trauma and depression
Psychotherapy is the recommended treatment for both PTSD and depression. Within therapy, trauma-focused treatments are often even more effective.
Therapies that address trauma may focus on:
- intrusive memories
- related thoughts
- avoidance and escape behaviors
If you decide to seek help for the aftereffects of a trauma, it can help to talk with a therapist who specializes or has experience in treating PTSD. They’ll be able to offer specifically designed therapies to meet the unique needs that people have after experiencing trauma.
Common treatments for PTSD include prolonged exposure (PE) and cognitive processing therapy (CPT).
For example, therapists may use exposure therapy to help you face and manage your fears in a safe environment. Therapists don’t tend to use these techniques for depression or other related disorders.
Psychotherapy for the treatment of depression may focus on:
- pinpointing life challenges that make depression worse and working on ways to improve them
- identifying negative thinking patterns contributing to depression
- improving patterns of interacting with others that contribute to depression
- assisting in finding opportunities to incorporate enjoyable activities
- working with a support system to help with therapy
Often, resolving PTSD can lead to a reduction of depressive symptoms without much intervention. Other times, skills learned from PTSD treatments like PE and CPT can be easily applied to depressive symptoms if those symptoms remain after PTSD is successfully treated.
In summary, depression and trauma can be linked. Though depression and PTSD can have overlapping symptoms, they are separate conditions. However, you can have both depression and PTSD at the same time.
Left untreated, depression and post-traumatic stress can worsen over time. But help is available, and with effective treatment, know that you don’t have to live with fear, sadness, and extreme stress.
I hope you find this article helpful as well as interesting.