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Depressive Disorders

Depression is a common post-deployment stress effect, and one that often accompanies other post-traumatic effects and substance use disorders. Of the people treated for posttraumatic stress disorder (PTSD), 48% receive a co-occurring diagnosis of depression (Shumake and Gonzalez-Lima, 2003).

Like PTSD and SUDs, depression also reflects challenges in many of the brain structures (e.g., prefrontal cortex, anterior cingulate gyrus, hippocampus, amygdala) and chemicals (e.g., dopamine, serotonin, norepinephrine, cortisol) that work to regulate stress responses. There are three types of major depression (APA, 1994):

  • Melancholic Depression includes a loss of pleasure in most or all activities (called “anhedonia”), an inability to respond to pleasurable stimuli, sadness deeper than that of grief or loss, trouble with sleep, and weight loss. Low levels of dopamine often contribute to the loss of pleasure in melancholic depression.
  • Atypical Depression is, ironically, the most common type, and includes weight gain or increased appetite, excessive sleep, a feeling of leaden paralysis, and hypersensitivity to perceived rejection by others. High levels of cortisol contribute to the weight gain, increased appetite, and loss of energy. Unlike people with melancholic depression, people with atypical depression can feel pleasure.
  • Depression With Psychotic Features also includes delusions or (less often) hallucinations that may be consistent with the major themes of the depression.

The larger category of depressive disorders includes both the unipolar depressive disorders (depressive episodes only) and bipolar disorders that involve both depressive episodes and manic episodes (with elevated, or irritable mood, sleeplessness, compulsive speech, distractibility, agitation, etc.).

A number of features of depression make sense as effects of prolonged or intense stress, including:

  • Difficulty regulating moods, often due to lower levels of serotonin (Neumeister, Young, and Stastny, 2004)
  • Difficulty experiencing pleasure, often due to lower levels of dopamine (Schumake and Gonzalez-Lima, 2003)
  • In some women and some people with atypical depression, more extreme responses to stress (e.g., weight gain, prolonged sleep, unstable emotions), possibly due to higher levels of cortisol (Schumake and Gonzalez-Lima, 2003)
  • Longer processing of negative and stressful experiences in the prefrontal cortex (Davidson, Pizzagalli, Nitschke, and Putnam, 2002)
  • A failure of the anterior cingulate gyrus to call on the prefrontal cortex and other regions for help in resolving the conflicts it perceives in the brain (Davidson, Pizzagalli, Nitschke, and Putnam, 2002)
  • Heightened perception of danger and unpleasant experiences, and greater access to unpleasant memories, in the amygdala (Davidson, Pizzagalli, Nitschke, and Putnam, 2002)
  • Levels of emotion that are out of context with the outside world, often due to problems with the perception and memory of positive and negative experiences in the hippocampus (Davidson, Pizzagalli, Nitschke, and Putnam, 2002)

Next: Complex PTSD or DESNOS


The material on all of the Clinical Pages is taken directly from the draft version of Finding Balance After the War Zone:  Considerations in the Treatment of Post-Deployment Stress Effects, a manual under development for the Great Lakes Addiction Technology Transfer Center and Human Priorities.  This draft is copyright © 2008, Pamela Woll.  Reprint permission is universally granted, but attribution is requested.
Click here for References and Other Resources.
Click here to link to a PDF file of the current version of the clinician’s manual draft.
Click here to link to a PDF file of the accompanying booklet for veterans.

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