Scott made a comment a couple of days ago that most PTSD symptoms could be subsumed into depression. This month’s British Journal of Psychiatry has a systematic review of the risk of depression following disaster. There is a moderate association: I generally don’t pay that much attention to odds ratios less than two, and would want an odds ratio of greater than four or six to talk about causality.
The papers and risk of depression as shown in this forest plot for natural disasters, technology disasters, terrorism and deployment. Please note a trend for the military being less at risk.
The average OR was significantly elevated following all types of exposures: natural disaster OR = 2.28 (95% CI 1.30–3.98), technological disaster OR = 1.44 (95% CI 1.21–1.70), terrorist acts OR = 1.80 (95% CI 1.38–2.34) and military combat OR = 1.60 (95% CI 1.09–2.35). In a subset of ten high-quality studies OR was 1.41 (95% CI 1.06–1.87).
J. P. Bonde, N. Utzon-Frank, and others. The British Journal of Psychiatry Feb 2016, DOI: 10.1192/bjp.bp.114.157859
We need to be quite cautious in saying something is causal. Koch’s postulates do not work as well when the causal agent is not a microbe. To say that Trauma is not associated with depression is foolish. To say it is causal is more so.
It all depends what you mean by depression – the diagnostic category of DSM Major Depressive Disorder (MDD) can hoover up a lot – maybe 20 percent of the population.
On the other hand this has almost nothing to do with melancholia/ endogenous/ psychotic depression as it was diagnosed pre 1970 – which was about 100 times less commonly diagnosed, and led to hospital admissions of several months and a death rate of about 25 % (mostly from suicide, also from dehydration and starvation).
To get a diagnosis of modern MDD you don’t need to be depressed in any significant way – because the term is now used for what used to be termed Anxiety Disorders – including PTSD which is now also massively over-diagnosed compared to its origins as Combat Fatigue/ Shell Shock.
this happened largely because the SSRI (Prozac type) drugs were falsely marketed as antidepressants, when they are really anti-anxiety drugs (of a kind); at any rate they are completely ineffective in real hospitalized depressions. They are instead used in the same kind of primary care patients who used to get Miltown, Barbiturates and Dexedrine (especially Dexamyl) in the fifties, and Librium, Valium and other benzos in the 1960s and 70s.
On the whole the older drugs were more effective, pleasanter and safer (see David Healy’s Let Them Eat Prozac, or Edward Shorter’s Before Prozac).
As for the correlations or lack thereof – Garbage in – Garbage out.
Hi Bruce. You are correct on MDE being the current formulation and not melancholia. Since I do inpatient work, my current treatment of such — yes melancholia still exists — is generally a modified TCA (Mirtazapine) in combination with and SSRI or Venlafaxine or, as of then these have ben tried (and most people cannot tolerate a full dose of a tricyclic an MOAI.
Or ECT. We are now doing ECT maintenence on some people with severe, melancholic depression.
And yes, they are a different population: I was not prescribing in the 1960s or 70s, so I don’t recall Milton etc.