Double Trouble: Treatment Considerations for Patients with Comorbid PTSD and Depression
- PDF / 411,952 Bytes
- 17 Pages / 595.276 x 790.866 pts Page_size
- 31 Downloads / 183 Views
PTSD (SK Creech and LM Sippel, Section Editors)
Double Trouble: Treatment Considerations for Patients with Comorbid PTSD and Depression Valerie Rosen, MD1,* Nicholas F. Ortiz, MD1 Charles B. Nemeroff, MD, PhD2 Address *,1 Department of Psychiatry, Dell Medical School, The University of Texas at Austin, Seton Mind Institute, Medical Park Tower, 1301 W. 38th Street, suite 700, Austin, TX, 78705, USA Email: [email protected] 2 Department of Psychiatry, Institute for Early Life Adversity Research, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
* Springer Nature Switzerland AG 2020
This article is part of the Topical Collection on PTSD Keywords Posttraumatic Stress Disorder I Depression I Comorbidity I Pharmacologic treatments I Psychotherapy I Neuromodulation
Abstract Purpose of review Posttraumatic stress disorder (PTSD) rarely occurs alone, with an approximate 80% syndromal comorbidity rate of which 50% is major depression. Evidence-based psychotherapy is the first-line treatment for PTSD and is very efficacious in some, but is directed toward PTSD symptomatology not depression, and many do not fully recover. This review presents the evidence for psychotherapy, pharmacotherapy, neurostimulation, and combinations of these modalities in treating PTSD with comorbid depression. Recent findings Modifications to evidence-based psychotherapy for PTSD and comorbid depression can be made to involve comorbid traumatic brain injury and early childhood adversity, and although effective, some studies show such adaptations may not be necessary. Burgeoning neuromodulation research holds promise for possible additions to the current first-line treatment and new core treatment options. Summary Cognitive processing therapy and prolonged exposure are the most cited effective treatments for PTSD; arguments for adding an antidepressant in cases of significant comorbid depression are supported by research. Treating PTSD first when comorbid with depression is supported by evidence that trauma-focused therapies reduce depressive
PTSD (SK Creech and LM Sippel, Section Editors) symptoms whereas depression-focused treatments do not show the same for comorbid PTSD. Future directions for study will involve new sequencing and combinations of current treatment modalities in addition to exploration of other factors including biomarkers, resiliency, and risk factors to inform novel treatment options for this population.
Introduction Posttraumatic stress disorder (PTSD) is a complex syndrome involving pathological changes in arousal and cognitive schemas that impacts both veteran and civilian populations following trauma. In the USA, approximately 70% of the population have experienced a traumatic event at some point in their lives, with roughly 20% developing PTSD [1]. Comorbidity is considered the rule rather than the exception in PTSD with estimates of over 80% of patients with PTSD meeting criteria for at least one other syndromal psychiatric disorder [2]. Approximately 50% of adults with PTSD have comorbid depr
Data Loading...
