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Trauma that leads to depression often starts with immediate shock and feelings of disorientation. People can feel quite shaken up. As the initial shock of the experience fades, people can find themselves feeling like their fundamental beliefs have been challenged and can experience the world in a very different, hypervigilant, stressful way. This can greatly hamper quality of life and lead to chronic feelings of depression. Although this is a common presentation, everyone's responses to trauma can vary greatly both in quality and severity.
An example of trauma that can lead to depression would be poor bonding with a parental figure or even worse, forms of abuse. This can greatly affect how someone perceives the world and how one can over time feel quite distrusting. If we cannot trust our parents, who can we trust? Situations of trauma with a parental figure can create a cascade. The individual misses a prime opportunity to learn about healthy relationships and may struggle to make friends and other relationships in the future. There can be symptoms of higher anxiety and poor sleep which impair their quality of life. In an odd way, if an individual continues to feel mistrust, they may hold back from others and deprive themselves of fruitful relationships further perpetuating the cycle.
Trauma has the ability to lead to depression because traumatic stress can cause lasting structural changes in the brain and include structures such as the amygdala, hippocampus, and prefrontal cortex. There can also be changes in reactions to future stressors such as higher cortisol levels and norepinephrine. There is also a psychological piece as traumatic events can understandably condition someone to expect more adversity in their life. Depression also impacts similar neurological pathways although it is also distinct from trauma.
Certain factors may make a person more prone to developing depression after experiencing trauma, according to research. They include:
Some of the above risk factors are not clearly understood. In my work with female patients with trauma, anecdotally I have been informed of a higher incidence of sexual trauma compared to males. Sexual trauma does tend to happen on repeated occasions and repeated traumatic events are more likely to create pervasive symptoms. For younger victims, some of this potentially stems from a not fully developed prefrontal cortex which is involved in our emotional well-being. The younger the person is, the more malleable their neurology is, for better or worse. Trauma symptoms tend to occur if you will, in a dose-dependent fashion. It is not much different from repeated physical injuries and longitudinal symptoms. Self-medicating with alcohol does worsen trauma as alcohol in and of itself is a depressant. It also decreases neuronal excitability and hampers cognition, creating a barrier for therapeutic cognitive processing of the trauma to occur in the healing process. The cognitive processing can be done in a therapy setting or even helpful self-reflection.
Some people also develop PTSD after traumatic experiences. The DSM V which is the diagnostic manual for psychiatric disorders describes many overlapping symptoms between PTSD and depression. These include persistent low mood, impairments in sleep, distorted ways of viewing the world for the worse, and poor concentration.
Having good social support systems can protect against developing PTSD or depression after experiencing trauma. There is evidence to show that those who develop PTSD may have internal risk factors as well as environmental. This is not unlike any ailment in medicine. Diabetes, for example, has genetic risk factors and environmental influences that partake in the development of the disorder. When trauma is not processed and healed appropriately, it can leave a person in a continued feeling of fight and flight. When processed, the person can feel more grounded and less chronically on edge or in distress. With processing, the individual is able to acknowledge what happened, and validate it, but not have it be the narrative for their future and they are able to feel more free to live and fully experience the present for the present as opposed to a potential repeat of the past.
There are strong peer-reviewed and empirical studies showing the efficacy of therapy and medication management when it comes to treating depression caused by trauma. Many medications are actually FDA-approved for trauma disorders. Together, they actually help normalize some of the neurochemistry and even promote structural normalization of areas of the brain.
Psychotherapy is also helpful in treating trauma-based depression, as some of the more widely evidence-based practiced modalities include cognitive processing, prolonged exposure, and EMDR, which can have positive impacts on the neuroscience of depression in patients.
The best-studied medications are the serotonergic agents. These are the SSRIs and SNRIs such as paroxetine, sertraline, venlafaxine, and more. Benzodiazepines are commonly used in PTSD, however, there is consistent literature demonstrating for many that these are not efficacious and are in fact potentially harmful due to their cognitive side effects which impair the ability to fully benefit from cognitive therapy. This is not to be construed as medical advice, each medication regimen must be reviewed case by case, but studies have indicated benzodiazepines do present a lot of risks as well as medical risk (e.g. falls and fractures).
No matter whether you have experienced trauma or not, if you are having feelings of depression that are negatively impacting your day-to-day life it is important to seek the help of a qualified professional psychotherapist about possible treatment options. They will be able to develop a treatment path tailored to help you deal with your depression and move into a more positive mindset.
