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Old 09-22-2014, 11:31 AM #1
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Default For those with PTSD "&" Treatment-Resistant Depression

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)

Quote:
“We know from previous clinical trials that antidepressants, for example, do not work well for dysphoria and the numbing symptoms often found in PTSD,” said Neumeister.

“Currently available antidepressants are just not linked specifically enough to the neurobiological basis of these symptoms in PTSD. Going forward, our study will help pave the way toward development of better options.”
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?
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Old 09-23-2014, 12:42 PM #2
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Default Re: For those with PTSD "&" Treatment-Resistant Depression

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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?
I don't think it should be, but as you already know I do not like the definition of two anti depressants not working. I am in total agreement with DocJohns definition-

Quote:
To me, and in this context, it means you've tried multiple treatment options -- whether it be psychotherapy, meds, ECT, TMS, whatever -- over a period of years and despite your (and your professionals') best efforts and multiple tries on different treatments (whether it be with different therapists, therapies, meds, etc.), very little has touched your depression. You are still depressed. It doesn't seem to have responded much to anything.

That's my definition. I'm going to close this thread to encourage you all to start new threads here on the topics of the most interest to you...
I do not have PTSD but I view it as depression is a symptom of PTSD along with other possible symptoms. A person might have PTSD and not have depression as a symptom and may have other symptoms. I agree with you that it is the PTSD that should be gone after. Maybe they are comorbid and should be treated at the same time but the primary focus should be the PTSD. My two cents anyway.

I googled "treatment resistant PTSD" to see what came up.

Treatment-resistant posttraumatic stress disorder... [CNS Spectr. 2004] - PubMed - NCBI Couldn't seem to find a link to the full article.
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Abstract
The mainstay of treatment for chronic posttraumatic stress disorder (PTSD) is a combination of psychotherapy and medication treatments. The first-line medications for PTSD are antidepressants, with two selective serotonin reuptake inhibitors (sertraline and paroxetine) currently Food and Drug Administration-indicated for PTSD. However, many patients do not have an adequate response to antidepressants, therefore, combinations with other antidepressants or with other classes of psychotropic medication are often utilized to enhance the therapeutic response. Other agents that have been used include mood stabilizers, anti-adrenergics, anxiolytics, and atypical antipsychotics. The heterogeneity of symptom clusters in PTSD as well as the complex psychiatric comorbidities (eg, with depression or substance abuse) further support the notion that combinations of medications may be needed. To date, there is a paucity of data to support specific strategies for augmenting antidepressants in PTSD. This review will address representative existing studies and discuss several potential pharmacologic strategies for patients suffering from treatment-refractory PTSD.
It seems MDMA (ecstasy) holds some promise.
I'm a veteran who overcame treatment-resistant PTSD after participating in a clinical study of MDMA-assisted psychotherapy. My name is Tony Macie? Ask me anything! : IAmA

MDMA Cures Treatment-Resistant PTSD « Reset.me

I seem to remember hearing on the news that the US Military and VA has come up with some novel psychotherapy methods of treatment. Not sure how successful.
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Old 12-08-2017, 05:00 PM #3
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Default Re: For those with PTSD "&" Treatment-Resistant Depression

You are right !
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Old 02-19-2018, 04:11 PM #4
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Old 02-20-2018, 02:57 PM #5
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Default Re: For those with PTSD "&" Treatment-Resistant Depression

[QUOTE=vonmoxie;4011206]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.

Your post has been very enlightening to me and I thank you. I've been treated for depression for decades: in and out of therapy, off and on medications. None of which have seemed very affective. Was diagnosed with PTSD 10 years ago. Only when I discovered this site 3 months ago and started perusing the many forums did I learn of complex PTSD. In hindsight, I probably should've been diagnosed decades ago with PTSD vs depression....but many too many secrets I didn't want to share because I had successfully buried them deep in a closet in my brain.

Genetic testing 4 to 5 years ago proved a missing gene had significant to moderate impact on most Rx drugs prescribed to me. Extremely validating for a moment! I know my body better than anyone and when I reported no improvement, I was considered "resistant". WTH? I WANT to feel better and if it's not working, it's just not working. Not everyone is tolerant of Rx drugs, sad to say. Big PHARMA is all about the money....not wellness.

Thanks for sharing and to you other members, thanks for adding to this thread!
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Old 02-20-2018, 03:53 PM #6
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Heart Re: For those with PTSD "&" Treatment-Resistant Depression

I wish much more was known about depression, PTSD/CPTSD and more mental health conditions.

I am all for trying meds to see if they do help.
I feel it's likely PTSD/CPTSD and depression co-exist in most cases.

Thanks for an interesting discussion.


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Old 02-20-2018, 04:50 PM #7
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Default Re: For those with PTSD "&" Treatment-Resistant Depression

my gut feeling is that there are different types of depression that are all lumped together under the same word. That is misleading.
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Old 02-22-2018, 05:30 PM #8
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Default Re: For those with PTSD "&" Treatment-Resistant Depression

Anyone tried TMS therapy? Transcranial Magnetic Stimulation. Read it on a new member's post this afternoon. Quick research I did looked promising. I'd be more willing to try this vs ECT. I've recently learned a lot about magnetic stimulation and quantum mechanics so this is appealing to me for a lot of reasons I can't explain.
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Old 02-28-2018, 08:59 AM #9
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Post Re: For those with PTSD "&" Treatment-Resistant Depression

Hi-

Thanks for the article. I have C-PTSD, and MDD. None of the meds have ever worked. Countless hours of therapy have brought me to the point in knowing I have childhood trauma....T states “mother yourself...treat yourself as you wanted to be treated as a child”. This is frustrating as I do not have to tools to do this. So I avoid going to T. I do isolate myself & I guess numbness is a good description. I basically exist.

I wish I could wave a magic wand and everyone’s pain would go away.
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Old 02-28-2018, 10:57 AM #10
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Default Re: For those with PTSD "&" Treatment-Resistant Depression

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Originally Posted by tecomsin View Post
my gut feeling is that there are different types of depression that are all lumped together under the same word. That is misleading.
Personally I think it helps to see depression as a symptom, one that can occur for many different reasons, rather than a particular clinical condition in itself. Same as pain is - there may be many causes and conditions that lead to the same symptom, but they all respond to treatment differently even if they have that one symptom in common.
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