Traumatic stress, depression and suicide

The psychological consequences of trauma exposure are well recognized throughout history. The study of post-traumatic stress disorder (PTSD) dates back more than 100 years. Before 1980, post-traumatic syndromes were recognized by different names, including railway spine, shell shock, traumatic (war) neurosis, concentration-camp syndrome, and rape-trauma syndrome. The symptoms described in these syndromes overlap considerably with what we now recognize as PTSD. Individuals exposed to severe traumatic stress often develop comorbid PTSD and major depressive disorder (MDD). I developed a new concept suggesting that that some or all individuals diagnosed with comorbid PTSD and MDD have a separate psychobiological condition that can be termed "post-traumatic mood disorder" (PTMD). This concept is supported by a significant number of clinical, translational and other studies suggesting that patients suffering from comorbid PTSD and MDD are different clinically and biologically from individuals with PTSD alone or MDD alone. Patients with comorbid PTSD and MDD are characterized by greater impairment compared to individuals with PTSD alone or MDD alone. Neurobiological evidence supporting the concept of PTMD includes the findings related to dopaminergic, serotonergic, and hypothalamic-pituitary-adrenal axis function and other observations. It is crucial to develop interventions to prevent and to treat PTMD and measures to prevent and to treat suicidal ideation and behavior in individuals with PTMD.