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Accessible Unlicensed Requires Authentication Published by De Gruyter August 31, 2020

Depression in post-traumatic stress disorder

Milen L. Radell, Eid Abo Hamza and Ahmed A. Moustafa


Major depressive disorder (MDD) symptoms commonly occur after trauma-exposure, both alone and in combination with post-traumatic stress disorder (PTSD). This article reviews recent research on comorbidity between these disorders, including its implications for symptom severity and response to treatment. Despite considerable symptom overlap, the two disorders represent distinct constructs and depend, at least in part, on separate biological mechanisms. Both, however, are also clearly related to stress psychopathology. We recommend that more research focus specifically on the study of individual differences in symptom expression in order to identify distinct subgroups of individuals and develop targeted treatments. However, a barrier to this line of inquiry is the trend of excluding particular patients from clinical trials of new interventions based on symptom severity or comorbidity. Another obstacle is the overreliance on self-report measures in human research. We argue that developing computer-based behavioral measures in order to supplement self-report can help address this challenge. Furthermore, we propose that these measures can help tie findings from human and non-human animal research. A number of paradigms have been used to model MDD-and PTSD-like behavior in animals. These models remain valuable for understanding the biological basis of these disorders in humans and for identifying potential interventions, but they have been underused for the study of comorbidity. Although the interpretation of animal behavior remains a concern, we propose that this can also be overcome through the development of close human analogs to animal paradigms.

Corresponding author: Ahmed A. Moustafa, School of Psychology, Western Sydney University, Sydney, NSW, Australia; Marcs Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, NSW, Australia; and Department of Human Anatomy and Physiology, The Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa, E-mail:

  1. Author contribution: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Conflict of interest statement: The authors declare no conflicts of interest regarding this article.


Abdallah, C.G., Roache, J.D., Averill, L.A., Young-McCaughan, S., Martini, B., Gueorguieva, R., and López-Roca, A.L. (2019). Repeated ketamine infusions for antidepressant-resistant PTSD: methods of a multicenter, randomized, placebo-controlled clinical trial. Contemp. Clini. Trials 81: 11–18, in Google Scholar

Akiki, T.J. and Abdallah, C.G. (2018). Are there effective psychopharmacologic treatments for PTSD? J. Clini. Psychiatry 80: 1–4, in Google Scholar

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, 5th ed. Washington, DC: Author.Search in Google Scholar

Angelakis, S. and Nixon, R.D. (2015). The comorbidity of PTSD and MDD: implications for clinical practice and future research. Behav. Change 32: 1–25, in Google Scholar

Armour, C., Elklit, A., Lauterbach, D., and Elhai, J.D. (2014a). The DSM-5 dissociative-PTSD subtype: can levels of depression, anxiety, hostility, and sleeping difficulties differentiate between dissociative-PTSD and PTSD in rape and sexual assault victims? J. Anxiety Disord. 28: 418–426, in Google Scholar

Armour, C., Karstoft, K.-I., and Richardson, J.D. (2014b). The co-occurrence of PTSD and dissociation: differentiating severe PTSD from dissociative-PTSD. Soc. Psychiatry Psychiatr. Epidemiol. 49: 1297–1306, in Google Scholar

Bernardy, N.C. and Friedman, M.J. (2017). Pharmacological management of posttraumatic stress disorder. Curr. Opin. Psychol. 14: 116–121, in Google Scholar

Bielawski, T., Misiak, B., Moustafa, A.A., and Frydecka, D. (2019). Epigenetic mechanisms, trauma and psychopathology: targeting chromatin remodeling complexes. Rev. Neurosci. 30: 595–604, in Google Scholar

Birrer, E. and Michael, T. (2011). Rumination in PTSD as well as in traumatized and non-traumatized depressed patients: a cross-sectional clinical study. Behav. Cognitive Psychother. 39: 381–397, in Google Scholar

Bliese, P.D., Wright, K.M., Adler, A.B., Thomas, J.L., and Hoge, C.W. (2007). Timing of postcombat mental health assessments. Psychol. Ser. 4: 141–148, in Google Scholar

Bramsen, I., Dirkzwager, A.J.E., van Esch, S.C.M., and van der Ploeg, H.M. (2001). Consistency of self-reports of traumatic events in a population of Dutch peacekeepers: reason for optimism? J. Traumatic Stress 14: 733–740, .Search in Google Scholar

Breslau, N., Davis, G.C., Peterson, E.L., and Schultz, L.R. (2000). A second look at comorbidity in victims of trauma: the posttraumatic stress disorder–major depression connection. Biol. Psychiatry 48: 902–909, in Google Scholar

Breslau, N. (2009). The epidemiology of trauma, PTSD, and other posttrauma disorders. Trauma Viol. Abuse 10: 198–210, in Google Scholar

Brewin, C.R., Andrews, B., and Hejdenberg, J. (2012). Recognition and treatment of psychological disorders during military service in the UK armed forces: a study of war pensioners. Soc. Psychiatry Psychiatr. Epidemiol. 47: 1891–1897, in Google Scholar

Brown, L.A., Jerud, A., Asnaani, A., Petersen, J., Zang, Y., and Foa, E.B. (2018). Changes in posttraumatic stress disorder (PTSD) and depressive symptoms over the course of prolonged exposure. J. Consult. Clin. Psychol. 86: 452–463, in Google Scholar

Burriss, L., Ayers, E., Ginsberg, J., and Powell, D.A. (2008). Learning and memory impairment in PTSD: relationship to depression. Depress. Anxiety 25: 149–157, in Google Scholar

Callahan, J.L., Maxwell, K., and Janis, B.M. (2019). The role of overgeneral memories in PTSD and implications for treatment. J. Psychother. Integration 29: 32–41, in Google Scholar

Campbell, D.G., Felker, B.L., Liu, C.-F., Yano, E.M., Kirchner, J.E., Chan, D., and Chaney, E.F. (2007). Prevalence of depression–PTSD comorbidity: implications for clinical practice guidelines and primary care-based interventions. J. Gen. Intern. Med. 22: 711–718, in Google Scholar

Carlson, K.F., Nelson, D., Orazem, R.J., Nugent, S., Cifu, D.X., and Sayer, N.A. (2010). Psychiatric diagnoses among Iraq and Afghanistan war veterans screened for deployment-related traumatic brain injury. J. Traumatic Stress 23: 17–24, in Google Scholar

Carlson, E.B., Dalenberg, C., and McDade-Montez, E. (2012). Dissociation in posttraumatic stress disorder part I: definitions and review of research. Psychol. Trauma: Theory, Research, Practice, Policy 4: 479–489, in Google Scholar

Chen, A.C. and Etkin, A. (2013). Hippocampal network connectivity and activation differentiates post-traumatic stress disorder from generalized anxiety disorder. Neuropsychopharmacology 38: 1889–1898, in Google Scholar

Chiba, H., Oe, M., and Uchimura, N. (2016). Patients with posttraumatic stress disorder with comorbid major depressive disorder require a higher dose of psychotropic drugs. Kurume Med. J. 62: 23–28.Search in Google Scholar

Claycomb, M.A., Wang, L., Sharp, C., Ractliffe, K.C., and Elhai, J.D. (2015). Assessing relations between PTSD’s dysphoria and reexperiencing factors and dimensions of rumination. PLoS ONE 10: 1–13, in Google Scholar

Contractor, A.A., Roley-Roberts, M.E., Lagdon, S., and Armour, C. (2017). Heterogeneity in patterns of DSM-5 posttraumatic stress disorder and depression symptoms: latent profile analyses. J. Affect Disord. 212: 17–24, in Google Scholar

Contractor, A.A., Greene, T., Dolan, M., and Elhai, J.D. (2018). Relations between PTSD and depression symptom clusters in samples differentiated by PTSD diagnostic status. J. Anxiety Disord. 59: 17–26, in Google Scholar

Cuijpers, P., Sijbrandij, M., Koole, S.L., Andersson, G., Beekman, A.T., and ReynoldsIIIC.F. (2014). Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. Focus 12: 347–358, in Google Scholar

DeViva, J.C. and Bloem, W.D. (2003). Symptom exaggeration and compensation seeking among combat veterans with posttraumatic stress disorder. J. Traumatic Stress 16: 503–507, .Search in Google Scholar

Duek, O., Kelmendi, B., Pietrzak, R.H., and Harpaz-Rotem, I. (2019). Augmenting the treatment of PTSD with ketamine—a review. Curr. Treatm. Opt. Psychiatry 6: 1–11, in Google Scholar

Duman, R.S. and Monteggia, L.M. (2006). A neurotrophic model for stress-related mood disorders. Biol. Psychiatry 59: 1116–1127, in Google Scholar

Dunkley, B.T., Doesburg, S.M., Sedge, P.A., Grodecki, R.J., Shek, P.N., Pang, E.W., and Taylor, M.J. (2014). Resting-state hippocampal connectivity correlates with symptom severity in post-traumatic stress disorder. NeuroImage: Clin. 5: 377–384, in Google Scholar

Ehlers, A. and Clark, D.M. (2000). A cognitive model of posttraumatic stress disorder. Behav. Res. Ther. 38: 319–345, in Google Scholar

Ehlers, A., Hackmann, A., and Michael, T. (2004). Intrusive re-experiencing in post-traumatic stress disorder: phenomenology, theory, and therapy. Memory 12: 403–415, in Google Scholar

Elwood, L.S., Hahn, K.S., Olatunji, B.O., and Williams, N.L. (2009). Cognitive vulnerabilities to the development of PTSD: a review of four vulnerabilities and the proposal of an integrative vulnerability model. Clin. Psychol. Rev. 29: 87–100, in Google Scholar

Enman, N.M., Arthur, K., Ward, S.J., Perrine, S.A., and Unterwald, E.M. (2015). Anhedonia, reduced cocaine reward, and dopamine dysfunction in a rat model of posttraumatic stress disorder. Biol. Psychiatry 78: 871–879, in Google Scholar

Evans, J., Sun, Y., McGregor, A., and Connor, B. (2012). Allopregnanolone regulates neurogenesis and depressive/anxiety-like behaviour in a social isolation rodent model of chronic stress. Neuropharmacology 63: 1315–1326, in Google Scholar

Farhood, L.F., Fares, S., Sabbagh, R., and Hamady, C. (2016). PTSD and depression construct: prevalence and predictors of co-occurrence in a South Lebanese civilian sample. Euro. J. Psychotraumatol. 7: 31509, in Google Scholar

Fava, M., Rush, A.J., Trivedi, M.H., Nierenberg, A.A., Thase, M.E., Sackeim, H.A., and Rosenbaum, J.F. (2003). Background and rationale for the sequenced treatment alternatives to relieve depression (STAR*D) study. Psychiatr. Clin. North America 26: 457–494, in Google Scholar

Feeny, N.C., Zoellner, L.A., Fitzgibbons, L.A., and Foa, E.B. (2000). Exploring the roles of emotional numbing, depression, and dissociation in PTSD. J. Traumatic Stress 13: 489–498, .Search in Google Scholar

Flory, J.D. and Yehuda, R. (2015). Comorbidity between post-traumatic stress disorder and major depressive disorder: alternative explanations and treatment considerations. Dialogu. Clin. Neurosci. 17: 141–150.Search in Google Scholar

Foa, E.B., Zinbarg, R., and Rothbaum, B.O. (1992). Uncontrollability and unpredictability in post-traumatic stress disorder: an animal model. Psychol. Bull 112: 218–238, in Google Scholar

Forbes, C.N., Tull, M.T., Xie, H., Christ, N.M., Brickman, K., Mattin, M., and Wang, X. (2020). Emotional avoidance and social support interact to predict depression symptom severity one year after traumatic exposure. Psychiatry Res. 284: 112746, in Google Scholar

Fournier, J.C., DeRubeis, R.J., Hollon, S.D., Dimidjian, S., Amsterdam, J.D., Shelton, R.C., and Fawcett, J. (2010). Antidepressant drug effects and depression severity: a patient-level meta-analysis. J. Am. Med. Assoc. 303: 47–53, in Google Scholar

Frueh, B.C., Elhai, J.D., Grubaugh, A.L., Monnier, J., Kashdan, T.B., Sauvageot, J.A., and Arana, G. W. (2005). Documented combat exposure of US veterans seeking treatment for combat-related post-traumatic stress disorder. British J. Psychiatry 186: 467–472, in Google Scholar

Garami, J., Valikhani, A., Parkes, D., Mahlberg, J., Haber, P., Misiak, B., Frydecka, D., and Moustafa, A.A. (2019). Examining perceived stress, childhood trauma and interpersonal trauma in individuals with drug addiction. Psychol. Rep. 122: 433–450, in Google Scholar

Glover, H. (1992). Emotional numbing: a possible endorphin-mediated phenomenon associated with post-traumatic stress disorders and other allied psychopathologic states. J. Traumatic Stress 5: 643–675, in Google Scholar

Goldstein, R.B., Smith, S.M., Chou, S.P., Saha, T.D., Jung, J., Zhang, H., and Grant, B.F. (2016). The epidemiology of DSM-5 posttraumatic stress disorder in the United States: results from the national epidemiologic survey on alcohol and related conditions-III. Soc. Psychiatry Psychiatr. Epidemiol. 51: 1137–1148, in Google Scholar

Gould, E. (2007). How widespread is adult neurogenesis in mammals? Nat. Rev. Neurosci. 8: 481–488, in Google Scholar

Gros, D.F., Simms, L.J., and Acierno, R. (2010). Specificity of posttraumatic stress disorder symptoms: an investigation of comorbidity between posttraumatic stress disorder symptoms and depression in treatment-seeking veterans. J. Nerv. Ment. Dis. 198: 885–890, in Google Scholar

Horesh, D., Lowe, S.R., Galea, S., Aiello, A.E., Uddin, M., and Koenen, K.C. (2017). An in-depth look into PTSD-depression comorbidity: a longitudinal study of chronically-exposed Detroit residents. J. Affect. Disord. 208: 653–661, in Google Scholar

Hurlocker, M.C., Vidaurri, D.N., Cuccurullo, L.-A.J., Maieritsch, K., and Franklin, C.L. (2018). Examining the latent structure mechanisms for comorbid posttraumatic stress disorder and major depressive disorder. J. Affect. Disord. 229: 477–482, in Google Scholar

Hyland, P., Shevlin, M., Fyvie, C., and Karatzias, T. (2018). Posttraumatic stress disorder and complex posttraumatic stress disorder in DSM-5 and ICD-11: clinical and behavioral correlates. J. Traumatic Stress 31: 174–180, in Google Scholar

Kashdan, T.B., Elhai, J.D., and Frueh, B.C. (2006). Anhedonia and emotional numbing in combat veterans with PTSD. Behav. Res. Ther. 44: 457–467, in Google Scholar

Kempermann, G. (2008). The neurogenic reserve hypothesis: what is adult hippocampal neurogenesis good for? Trends Neurosci. 31: 163–169, in Google Scholar

Kilpatrick, D.G., Resnick, H.S., Milanak, M.E., Miller, M.W., Keyes, K.M., and Friedman, M.J. (2013). National estimates of exposure to traumatic events and PTSD prevalence using DSM-IV and DSM-5 criteria. J. Traumatic Stress 26: 537–547, in Google Scholar

Kim, E.J., Pellman, B., and Kim, J.J. (2015). Stress effects on the hippocampus: a critical review. Learn. Memory 22: 411–416, in Google Scholar

Kirsch, I., Deacon, B.J., Huedo-Medina, T.B., Scoboria, A., Moore, T.J., and Johnson, B.T. (2008). Initial severity and antidepressant benefits: a meta-analysis of data submitted to the food and drug administration. PLOS Med. 5: 1–9, in Google Scholar

Kirsch, I. (2009). Antidepressants and the placebo response. Epidemiol. Psychiatric. Sci. 18: 318–322, in Google Scholar

Kleim, B. and Ehlers, A. (2008). Reduced autobiographical memory specificity predicts depression and posttraumatic stress disorder after recent trauma. J. Consult. Clin. Psychol. 76: 231–242, in Google Scholar

Kyung, Y., Yanes-Lukin, P., and Roberts, J.E. (2016). Specificity and detail in autobiographical memory: same or different constructs? Memory 24: 272–284, in Google Scholar

Labbate, L.A., Sonne, S.C., Randal, C.L., Anton, R.F., and Brady, K.T. (2004). Does comorbid anxiety or depression affect clinical outcomes in patients with post-traumatic stress disorder and alcohol use disorders? Compr. Psychiatry 45: 304–310, in Google Scholar

Lavender, A. and Watkins, E. (2004). Rumination and future thinking in depression. Br. J. Clin. Psychol. 43: 129–142, in Google Scholar

Lehavot, K., Der-Martirosian, C., Simpson, T.L., Sadler, A.G., and Washington, D.L. (2013). Barriers to care for women veterans with posttraumatic stress disorder and depressive symptoms. Psychol. Serv. 10: 203, in Google Scholar

Lisieski, M.J., Eagle, A.L., Conti, A.C., Liberzon, I., and Perrine, S.A. (2018). Single-prolonged stress: a review of two decades of progress in a rodent model of post-traumatic stress disorder. Front. Psychiatry 9: 1–22, in Google Scholar

Liverant, G.I., Suvak, M.K., Pineles, S.L., and Resick, P.A. (2012). Changes in posttraumatic stress disorder and depressive symptoms during cognitive processing therapy: evidence for concurrent change. J. Consult. Clin. Psychol. 80: 957–967, in Google Scholar

Locher, C., Kossowsky, J., Gaab, J., Kirsch, I., Bain, P., and Krummenacher, P. (2015). Moderation of antidepressant and placebo outcomes by baseline severity in late-life depression: a systematic review and meta-analysis. J. Affect. Disord. 181: 50–60, in Google Scholar

Maercker, A., Michael, T., Fehm, L., Becker, E.S., and Margraf, J. (2004). Age of traumatisation as a predictor of post-traumatic stress disorder or major depression in young women. British J. Psychiatry 184: 482–487, in Google Scholar

Maheux, A. and Price, M. (2016). The indirect effect of social support on post-trauma psychopathology via self-compassion. Pers. Individ. Differ. 88: 102–107, in Google Scholar

McGoey, L. (2010). Profitable failure: antidepressant drugs and the triumph of flawed experiments. Hist. Human Sci. 23: 58–78, in Google Scholar

McNally, R.J., Lasko, N.B., Macklin, M.L., and Pitman, R.K. (1995). Autobiographical memory disturbance in combat-related posttraumatic stress disorder. Behav. Res. Ther. 33: 619–630, in Google Scholar

Melcangi, R.C. and Panzica, G.C. (2014). Allopregnanolone: state of the art. Progr. Neurobiol. 113: 1–5, in Google Scholar

Merckelbach, H., Dandachi-FitzGerald, B., van Helvoort, D., Jelicic, M., and Otgaar, H. (2019). When patients overreport symptoms: more than just malingering. Curr. Direct. Psychol. Sci. 28: 321–326, in Google Scholar

Miller, B.R. and Hen, R. (2015). The current state of the neurogenic theory of depression and anxiety. Curr. Opin. Neurobiol. 30: 51–58, in Google Scholar

Miller, M.W. (2020). Leveraging genetics to enhance the efficacy of PTSD pharmacotherapies. Neurosci. Lett. 726: 133562, in Google Scholar

Morris, M.C., Compas, B.E., and Garber, J. (2012). Relations among posttraumatic stress disorder, comorbid major depression, and HPA function: a systematic review and meta-analysis. Clin. Psychol. Rev. 32: 301–315, in Google Scholar

Moustafa, A.A., Gilbertson, M.W., Orr, S.P., Servatius, R.J., and Myers, C.E. (2013). A model of amygdala-hippocampal-prefrontal interaction in fear conditioning and extinction in animals. Br. Cognition 81: 29–43, in Google Scholar

Moustafa, A.A., Parkes, D., Fitzgerald, L., Underhill, D., Garami, J., Levy-Gigi, E., Stramecki, F., Valikhani, A., Frydecka, D. and Misiak, B. (2018). The relationship between childhood trauma, early-life stress, and alcohol and drug use, abuse, and addiction: an integrative review. Curr. Psychol. in Google Scholar

Moustafa, A.A. (2013). Increased hippocampal volume and gene expression following cognitive behavioral therapy in PTSD. Front. Human Neurosci. 7: 747, in Google Scholar

Myers, C.E., Moustafa, A.A., Sheynin, J., VanMeenen, K.M., Gilbertson, M.W., Orr, S.P., Beck, K. B., Pang, K.C.H., and Servatius, R.J. (2013). Learning to obtain reward, but not avoid punishment, is affected by presence of PTSD symptoms in male veterans: empirical data and computational model. PLoS One 8: e72508, in Google Scholar

Nichter, B., Haller, M., Norman, S., and Pietrzak, R.H. (2020). Risk and protective factors associated with comorbid PTSD and depression in U.S. military veterans: results from the national health and resilience in veterans study. J. Psychiatr. Res. 121: 56–61, in Google Scholar

Nillni, Y.I., Nosen, E., Williams, P.A., Tracy, M., Coffey, S.F., and Galea, S. (2013). Unique and related predictors of major depressive disorder, posttraumatic stress disorder, and their comorbidity following Hurricane Katrina. J. Nerv. Ment. Dis. 201: 841–847, in Google Scholar

Olatunji, B.O., Naragon-Gainey, K., and Wolitzky-Taylor, K.B. (2013). Specificity of rumination in anxiety and depression: a multimodal meta-analysis. Clin. Psychol. Sci. Practice 20: 225–257, in Google Scholar

Otto, M.W., Hinton, D., Korbly, N.B., Chea, A., Ba, P., Gershuny, B.S., and Pollack, M.H. (2003). Treatment of pharmacotherapy-refractory posttraumatic stress disorder among Cambodian refugees: a pilot study of combination treatment with cognitive-behavior therapy vs. sertraline alone. Behav. Res. Ther. 41: 1271–1276, in Google Scholar

Park, S.-C. (2019). Neurogenesis and antidepressant action. Cell Tissue Res. 377: 95–106, in Google Scholar

Patki, G., Li, L., Allam, F., Solanki, N., Dao, A.T., Alkadhi, K., and Salim, S. (2014). Moderate treadmill exercise rescues anxiety and depression-like behavior as well as memory impairment in a rat model of posttraumatic stress disorder. Physiol. Behav. 130: 47–53, in Google Scholar

Payne, A., Kralj, A., Young, J., and Meiser-Stedman, R. (2019). The prevalence of intrusive memories in adult depression: a meta-analysis. J. Affect. Disord. 253: 193–202, in Google Scholar

Pineles, S.L., Nillni, Y.I., Pinna, G., Irvine, J., Webb, A., Arditte Hall, K.A., Hauger, R., Miller, M. W., Resick, P.A., Orr, S.P., et al. (2018). PTSD in women is associated with a block in conversion of progesterone to the GABAergic neurosteroids allopregnanolone and pregnanolone measured in plasma. Psychoneuroendocrinology 93: 133–141, in Google Scholar

Porcu, P., Barron, A.M., Frye, C.A., Walf, A.A., Yang, S.-Y., He, X.-Y., Morrow, A.L., Panzica, G. C., and Melcangi, R.C. (2016). Neurosteroidogenesis today: novel targets for neuroactive steroid synthesis and action and their relevance for translational research. J. Neuroendocrinol. 28, in Google Scholar

Post, L.M., Zoellner, L.A., Youngstrom, E., and Feeny, N.C. (2011). Understanding the relationship between co-occurring PTSD and MDD: symptom severity and affect. J. Anxiety Disord 25: 1123–1130, in Google Scholar

Raabe, F.J. and Spengler, D. (2013). Epigenetic risk factors in PTSD and depression. Front. Psychiatry 4, in Google Scholar

Radell, M.L., Myers, C.E., Beck, K.D., Moustafa, A.A., and Allen, M.T. (2016). The personality trait of intolerance to uncertainty affects behavior in a novel computer-based conditioned place preference task. Front. Psychol. 7: 1–14, in Google Scholar

Radell, M.L.,Myers, C.E., Sheynin, J., and Moustafa, A.A. (2017). Computational models of post-traumatic stress disorder (PTSD). In: Moustafa, A. (Ed.). Computational models of brain and behavior. Wiley-Blackwell.Search in Google Scholar

Radell, M.L., Allen, M.T., Favaloro, B., Myers, C.E., Haber, P., Morley, K., and Moustafa, A.A. (2018). Intolerance of uncertainty and conditioned place preference in opioid addiction. Peer J. 6: 1–19, in Google Scholar

Rasmusson, A.M. and Pineles, S.L. (2018). Neurotransmitter, peptide, and steroid hormone abnormalities in PTSD: biological endophenotypes relevant to treatment. Curr. Psychiatry Repor. 20: 52, in Google Scholar

Reynolds, M. and Brewin, C.R. (1999). Intrusive memories in depression and posttraumatic stress disorder. Behav. Res. Ther. 37: 201–215, in Google Scholar

Roemer, L., Litz, B.T., Orsillo, S.M., Ehlich, P.J. and Friedman, M.J. (1998). Increases in retrospective accounts of war-zone exposure over time: the role of PTSD symptom severity. J. Traumatic Stress 11: 597–605, .Search in Google Scholar

Roley, M.E., Claycomb, M.A., Contractor, A.A., Dranger, P., Armour, C., and Elhai, J.D. (2015). The relationship between rumination, PTSD, and depression symptoms. J. Affect. Disord. 180: 116–121, in Google Scholar

Rosebrock, L.E., Arditte Hall, K.A., Rando, A., Pineles, S.L., and Liverant, G.I. (2019). Rumination and its relationship with thought suppression in unipolar depression and comorbid PTSD. Cognit. Ther. Res. 43: 226–235, in Google Scholar

Rothbaum, B.O., Cahill, S.P., Foa, E.B., Davidson, J.R.T., Compton, J., Connor, K.M., and Hahn, C.-G. (2006). Augmentation of sertraline with prolonged exposure in the treatment of posttraumatic stress disorder. J. Traumatic Stress 19: 625–638, in Google Scholar

Rubacka, J.M., Schmeidler, J., Nomura, Y., Luthra, R., Rajendran, K., Abramovitz, R., and Chemtob, C.M. (2008). The relationship between PTSD arousal symptoms and depression among mothers exposed to the world trade center attacks. J. Nerv. Ment. Dis. 196: 504–507, in Google Scholar

Sahay, A. and Hen, R. (2007). Adult hippocampal neurogenesis in depression. Nat. Neurosci. 10: 1110–1115, in Google Scholar

Sartor, C.E., Grant, J.D., Lynskey, M.T., McCutcheon, V.V., Waldron, M., Statham, D.J., Bucholz, K.K., Madden, P.A.F., Heath, A.C., Martin, N.G., et al. (2012). Common heritable contributions to low-risk trauma, high-risk trauma, posttraumatic stress disorder, and major depression. Arch. Gen .Psychiatry 69: 293–299, in Google Scholar

Schüle, C., Nothdurfter, C., and Rupprecht, R. (2014). The role of allopregnanolone in depression and anxiety. Progr. Neurobiol. 113: 79–87, in Google Scholar

Schwartz, J., Murrough, J.W., and Iosifescu, D.V. (2016). Ketamine for treatment-resistant depression: recent developments and clinical applications. Evid. Based Ment. Health 19: 35–38, in Google Scholar

Sher, L., Stanley, B.H., Posner, K., Arendt, M., Grunebaum, M.F., Neria, Y., and Oquendo, M.A. (2012). Decreased suicidal ideation in depressed patients with or without comorbid posttraumatic stress disorder treated with selective serotonin reuptake inhibitors: an open study. Psychiatry Res. 196: 261–266, in Google Scholar

Sheynin, J., Moustafa, A.A., Beck, K.D., Servatius, R.J., Casbolt, P.A., Haber, P., and Myers, C. E. (2016). Exaggerated acquisition and resistance to extinction of avoidance behavior in treated heroin-dependent males. J. Clin. Psychiatry 77: 386–394, in Google Scholar

Sheynin, J., Shind, C., Radell, M., Ebanks-Williams, Y., Gilbertson, M.W., Beck, K.D., and Myers, C.E. (2017). Greater avoidance behavior in individuals with posttraumatic stress disorder symptoms. Stress (Amsterdam) 20: 285–293, in Google Scholar

Sheynin, J., Myers, C.E., Ghafar, F., Morris, A.N., Morley, K.C., Haber, P.S., and Moustafa, A.A. (2019). A pilot study of escape, avoidance, and approach behaviors in treated alcohol-dependent males. J. Clin. Exp. Neuropsychol. 41: 601–614, in Google Scholar

Spiegel, D. (1997). Trauma, dissociation, and memory. Ann. NY Acad. Sci. 821: 225–237, in Google Scholar

Spinhoven, P., Penninx, B.W., van Hemert, A.M., de Rooij, M., and Elzinga, B.M. (2014). Comorbidity of PTSD in anxiety and depressive disorders: prevalence and shared risk factors. Child Abuse Neglect. 38: 1320–1330, in Google Scholar

Stander, V.A., Thomsen, C.J., and Highfill-McRoy, R.M. (2014). Etiology of depression comorbidity in combat-related PTSD: a review of the literature. Clin. Psychol. Rev. 34: 87–98, in Google Scholar

Steiner, A.J., Boulos, N., Mirocha, J., Wright, S.M., Collison, K.L., and IsHak, W.W. (2017). Quality of life and functioning in comorbid posttraumatic stress disorder and major depressive disorder after treatment with citalopram monotherapy. Clin. Neuropharmacol. 40: 16–23.Search in Google Scholar

Steuwe, C., Lanius, R.A., and Frewen, P.A. (2012). Evidence for a dissociative subtype of PTSD by latent profile and confirmatory factor analyses in a civilian sample. Depress. Anxiety 29: 689–700, in Google Scholar

Tanner, A.K., Hasking, P., and Martin, G. (2014). Effects of rumination and optimism on the relationship between psychological distress and non-suicidal self-injury. Preven. Sci. 15: 860–868, in Google Scholar

Tucker, P., Beebe, K.L., Burgin, C., Wyatt, D.B., Parker, D.E., Masters, B.K., and Nawar, O. (2004). Paroxetine treatment of depression with posttraumatic stress disorder: effects on autonomic reactivity and cortisol secretion. J. Clin. Psychopharmacol. 24: 131–140, in Google Scholar

Ullman, S.E., Townsend, S.M., Filipas, H.H., and Starzynski, L.L. (2007). Structural models of the relations of assault severity, social support, avoidance coping, self-blame, and ptsd among sexual assault survivors. Psychol. Women Quarter. 31: 23–37, in Google Scholar

VanElzakker, M.B., Kathryn Dahlgren, M., Caroline Davis, F., Dubois, S., and Shin, L.M. (2014). From pavlov to PTSD: the extinction of conditioned fear in rodents, humans, and anxiety disorders. Neurobiol. Learn. Mem. 113: 3–18, in Google Scholar

Verdejo-García, A., Lawrence, A.J., and Clark, L. (2008). Impulsivity as a vulnerability marker for substance-use disorders: review of findings from high-risk research, problem gamblers and genetic association studies. Neurosci. Biobehav. Rev. 32: 777–810, in Google Scholar

Vidaña, A.G., Forbes, C.N., Gratz, K.L., and Tull, M.T. (2020). The influence of posttraumatic stress disorder and recurrent major depression on risk-taking propensity following trauma script exposure among patients with substance use disorders. Addict. Behav. 102: 106181, in Google Scholar

Wang, Q., Shelton, R.C., and Dwivedi, Y. (2018). Interaction between early-life stress and FKBP5 gene variants in major depressive disorder and post-traumatic stress disorder: a systematic review and meta-analysis. J. Affect. Disord. 225: 422–428, in Google Scholar

Wild, J., Smith, K.V., Thompson, E., Béar, F., Lommen, M.J.J., and Ehlers, A. (2016). A prospective study of pre-trauma risk factors for post-traumatic stress disorder and depression. Psychol. Med. 46: 2571–2582, in Google Scholar

Wisco, B.E., Miller, M.W., Wolf, E.J., Kilpatrick, D., Resnick, H.S., Badour, C.L., and Friedman, M.J. (2016). The impact of proposed changes to ICD-11 on estimates of PTSD prevalence and comorbidity. Psychiatry Res. 240: 226–233, in Google Scholar

Wolf, E.J., Lunney, C.A., Miller, M.W., Resick, P.A., Friedman, M.J., and Schnurr, P.P. (2012a). The dissociative subtype of PTSD: a replication and extension. Depress. Anxiety 29: 679–688, in Google Scholar

Wolf, E.J., Miller, M.W., Reardon, A.F., Ryabchenko, K.A., Castillo, D., and Freund, R. (2012b). A latent class analysis of dissociation and posttraumatic stress disorder: evidence for a dissociative subtype. Arch. Gen. Psychiatry 69: 698–705, in Google Scholar

World Health Organization. (2018). International statistical classification of diseases and related health problems (11th Revision).Search in Google Scholar

Wright, K.M., Britt, T.W., Bliese, P.D., Adler, A.B., Picchioni, D., and Moore, D. (2011). Insomnia as predictor versus outcome of PTSD and depression among Iraq combat veterans. J. Clin. Psychol. 67: 1240–1258, in Google Scholar

Zimmerman, M., Balling, C., Chelminski, I., and Dalrymple, K. (2019). Have treatment studies of depression become even less generalizable? Applying the inclusion and exclusion criteria in placebo-controlled antidepressant efficacy trials published over 20 years to a clinical sample. Psychother. Psychosom. 88: 165–170, in Google Scholar

Zimmerman, M. (2019). Severity and the treatment of depression: a review of two controversies. J. Nerv. Ment. Dis. 207: 219–223, in Google Scholar

Received: 2020-02-02
Accepted: 2020-05-31
Published Online: 2020-08-31
Published in Print: 2020-10-25

© 2020 Walter de Gruyter GmbH, Berlin/Boston