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Feelings of depression during PTSD treatment not indicative of negative outcomes

Patients with posttraumatic stress disorder experienced rapid fluctuations in depression symptoms during treatment, but without marked long-term negative effects, according to a study in The Journal of Consulting and Clinical Psychology.

Two hundred men and women diagnosed with chronic PTSD participated in the study. Patients had a mean age of 37 years. The average amount of time since initial trauma was about 12 years; inciting incidents for PTSD included child and adult sexual assault, adult nonsexual assault, accident, death or violence to a loved one, and combat/war. Researchers conducted clinical interviews to evaluate PTSD symptoms and participants completed numerous questionnaires to determine depression and PTSD severity, general social support, trauma-related social support, and social satisfaction. Study participants received either 10 weeks of exposure therapy or pharmacotherapy with sertraline.

Data showed 34% of study participants experienced a significant fluctuation in their depression symptoms during PTSD treatment. About a quarter of the study cohort experienced an increase in depression symptoms, while 18% experienced a decrease. Both forms of PTSD treatment, exposure therapy and pharmacotherapy, had similar rates of fluctuation in depression symptoms. Researchers found that those who experienced a decrease in depression symptoms had lower PTSD and depression severity post-treatment. A lack of trauma-related support was associated with increased feelings of depression during treatment.

Study researcher Stephanie M. Keller, MA, of Case Western Reserve University, and colleagues concluded that although clinicians are often concerned about implementing prescribed PTSD treatments in patients who have comorbid depression, transient depression spikes were not detrimental to treatment outcomes. “Research examining therapeutic change processes, including symptom discontinuities, can potentially improve current treatment options and fill the “gaps” in evidence-based practice,” the researchers wrote. “…Overall, understanding how depression symptoms change during PTSD treatment may help us to better tailor our current PTSD treatments to better fit individual needs.”

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