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.

I would suggest that there must be some portion of people whose "treatment-resistant depression" is actually representative of the depressive symptoms of PTSD/CPTSD, and would be better regarded as such. Myself among them.

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 thinking it is counter-productive, for me or anyone trying to treat me, to look at my depressive symptoms as being related to MDD or any other depressive disorder, when the better part of them are likely and rather the result of what is ultimately physical injury, but is termed psychiatric injury and is part and parcel of PTSD. 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 wouldn't go so far as asserting that PTSD and depressive disorders could not be comorbid, I think what has been found in this study makes it clear that screening for PTSD up front is essential, and that treating depressive symptoms in the traditional manner when PTSD is present should be a more carefully considered option. Certainly not 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.

After all, riddle me this, in cases where a treatment is neither applicable nor indicated, how can its ineffectiveness then describe a condition as being treatment-resistant?