The Combination of Major Depressive Disorder and CPTSD
Living with complex post-traumatic stress disorder (CPTSD) is complicated and takes many years to overcome. However, add the major depressive disorder (MDD) diagnosis on top, and you have a dangerous combination.
This article will explain how CPTSD and MDD can interact and feed off one another, plus treatments that work.
Depression does not include feeling down due to disappointment or grief unless those feelings do not subside. Also, depression types cause a disruption in everyday living where feeling down does not. Usually, you can recover quickly from disappointment, but minor and major depression often need medical intervention.
Minor depression, also called everyday depression, is a mental health diagnosis and will not always disappear without professional intervention. Minor depression exists when someone has at least two symptoms of major depression but not more than five, and they must persist for at least two weeks.
While it is called minor depression, it can have some pretty severe symptoms, including the following:
- Depressed mood almost every day for most of the day
- Insomnia or sleeping too much
- Changes in appetite
- Changes in weight
- Feelings and thoughts of worthlessness
- Feelings and thoughts of inappropriate guilt
- Thoughts of suicide
The main difference between minor and major depression is that people experiencing minor depression have only a few symptoms, and their condition is milder.
Major Depressive Disorder
Major depression is a mood disorder that causes a persistent feeling of sadness and loss of interest in everyday life. Also known as clinical depression, major depressive disorder affects how you think, feel, and behave, leading to many emotional and physical problems (Bains et al., 2022).
More than the blues, major depression is a medical disorder, and people cannot “just snap out of it.” This type of depression may require long-term treatment and medicinal usage to curb its disturbing symptoms.
Below is a list of the symptoms of major depression. Some you will recognize from the list for minor depression, but people with major depression have their symptoms last longer and have more of them.
- Feelings of sadness
- Feelings of hopelessness
- Being tearful and feeling empty
- Angry outbursts over small events
- Loss of interest in things that once brought pleasure, such as sex and hobbies
- Sleeping too much or too little
- Lack of energy so that small tasks take extra effort
- Lack of appetite
- Weight loss or gain
- Suicidal thoughts or actions
- Slow thinking, body movements, or speaking
- Fixation on past failures
- Trouble concentrating, remembering things, and making decisions
- Unexplained physical ailments such as headaches or back pain
The treatment for major depressive disorder includes psychotherapy and medications such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), atypical antidepressants, and serotonin modulators (Belmaker & Agam, 2008).
Psychotherapy and medications are often indicated to be performed together for the best results. Psychotherapy is a benefit by helping people to develop new coping skills and more adaptive ways of thinking.
Complex Post-traumatic Stress Disorder with Depression
Complex post-traumatic stress disorder is a trauma-related condition where people, especially young children, have experienced extremely traumatic events. CPTSD has many symptoms and may include those for PTSD with one of them being depression (Yu et al., 2019)
There is a definitive link between CPTSD and major depression.
Research has found that people who experience CPTSD and major depression are very common, with nearly half receiving the diagnosis of MDD across many samples (Angelakis & Nixon, 2015).
Further research suggests that at midlife, women who live with the co-occurring conditions of MDD and CPTSD had an increased rate of death compared to those without the disorders (Roberts & Kubzansky, 2020).
Much of the risk of having both MDD and CPTSD is the possibility of suicidal thoughts and actions (Flory & Yehuda, 2022). If this fact resonates with you and you or someone you know is feeling like dying by suicide, please, seek help. You are much too valuable to the world to lose you.
Help is available in many forms.
- Call or text 988, the Suicide & Crisis Lifeline in the United States.
- You can also chat online with someone at 988lifeline.org/chat
- Call an ambulance for yourself or someone you know who is suicidal (911)
- Call your doctor or their nurse and tell them you have an emergency and need urgent care
- Go to your nearest hospital to the emergency department
No matter what you do, take the necessary steps to safeguard your life.
Treatment for MDD and CPTSD
What happens if you leave complex PTSD and major depression untreated?
The combination of complex post-traumatic stress disorder and major (or minor) depression raises the risk of forming other disorders such as anxiety, addiction, and non-suicidal self-harm (Angelakis & Nixon, 2015).
Unfortunately, many who live with CPTSD and MDD often mask their pain. However, as life events and the pressure mount, the pain held beneath the facade can suddenly burst out. Hiding your disorders behind a cloak of normalcy will someday suddenly end, and how you genuinely feel could bring considerable changes to your life if left untreated.
The treatment regimen for both complex post-traumatic stress disorder and major depression overlap and includes:
Psychotherapy — Also known as talk therapy, this type of treatment allows the person living with both conditions to explore the deep causes of the distress they are feeling. This type of treatment may take anywhere from a few weeks to several years.
Cognitive Behavioral Therapy (CBT)- CBT is a psycho-social intervention with the aim of reducing the symptoms of both MDD and CPTSD. CBT focuses on challenging and changing cognitive distortions (thoughts, beliefs, or attitudes that make you feel bad about yourself).
Cognitive behavioral therapy improves emotional regulation and presents personal coping strategies targeting current problems to the person.
Eye Movement Desensitization and Reprocessing (EMDR)- Francine Shapiro developed this form of psychotherapy in the 1980s, initially designed to alleviate the distress associated with having traumatic memories. In an EMDR treatment, the person recalls distressing experiences while doing bilateral stimulation, such as physical stimulation or side-to-side eye movements.
The bottom line is that these treatments work for most people and can help you to learn how to circumnavigate the traumatic memories of what happened long ago.
Ending Our Time Together
Having both depression and complex post-traumatic stress disorder is a challenge, but it is treatable. Having any form of mental health problem is never a death sentence or a life-long struggle. While the memories that caused CPTSD will remain, once worked through with a qualified therapist, their power lessens, and your life will go on.
The most powerful message this piece was meant to convey is that you are worthwhile and wonderful and deserve to live a life full of love and contentment.
“Mental health…is not a destination, but a process. It’s about how you drive, not where you’re going.” — Noam Shpancer, PhD
“Promise me you’ll always remember: You’re braver than you believe and stronger than you seem, and smarter than you think.” — Christopher Robin from Winnie the Pooh
Angelakis, S., & Nixon, R. D. (2015). The comorbidity of PTSD and MDD: Implications for clinical practice and future research. Behaviour Change, 32(1), 1–25. Retrieved from: https://www.cambridge.org/core/journals/behaviour-change/article/comorbidity-of-ptsd-and-mdd-implications-for-clinical-practice-and-future-research/CD57D5F0A9465E94CA4F3A7E1A43199C#
Bains, N., Abdijadid, S., & Miller, J. L. (2022). Major Depressive Disorder (Nursing). In StatPearls [Internet]. StatPearls Publishing.Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK570554/
Belmaker, R. H., & Agam, G. (2008). Major depressive disorder. New England Journal of Medicine, 358(1), 55–68. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK559078/
Flory, J. D., & Yehuda, R. (2022). Comorbidity between post-traumatic stress disorder and major depressive disorder: alternative explanations and treatment considerations. Dialogues in clinical neuroscience. Retrieved from:
Roberts, A. L., Kubzansky, L. D., Chibnik, L. B., Rimm, E. B., & Koenen, K. C. (2020). Association of post-traumatic stress and depressive symptoms with mortality in women. JAMA network open, 3(12), e2027935-e2027935. Retrieved from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2773541
Yu, M., Linn, K. A., Shinohara, R. T., Oathes, D. J., Cook, P. A., Duprat, R., … & Sheline, Y. I. (2019). Childhood trauma history is linked to abnormal brain connectivity in major depression. Proceedings of the National Academy of Sciences, 116(17), 8582–8590. Retrieved from: https://www.pnas.org/doi/10.1073/pnas.1900801116#:~:text=In%20addition%2C%20experiences%20of%20childhood,and%20anxiety%20disorders%20(4).