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Veterans with PTSD and TBI can improve with treatment despite having depression

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Coming home from war with post traumatic stress syndrome and a traumatic brain injury requires treatment. But the treatment often works — even for veterans also battling major depression.

A recent study found that a group of veterans with traumatic brain injury (TBI) being treated for post traumatic stress syndrome (PTSD) all improved after treatment. Even those with depression improved.

"Get treatment for PTSD."

The study, led by Kristen H. Walter, of the Cincinnati VA Medical Center's PTSD and Anxiety Disorders Clinic in Cincinnati, aimed to find out how having major depression affected the recovery of servicemen diagnosed with PTSD and TBI.

The study involved 47 male veterans with PTSD and TBI who were undergoing an 8-week residential treatment program using Cognitive Processing Therapy.

The majority of these vets — 79 percent — reported combat as their primary stressor for the PTSD, but a handful identified other stressors that included sexual assault, a car accident, watching a person die, physical assault and a sudden, unexpected death.

All of the veterans' traumatic brain injury had occurred at least one year before the study began. Only two of the veterans had severe TBI, 38 percent had moderate TBI and the majority (68 percent) had mild TBI.

The researchers wanted to compare the treatment outcomes of the men who had major depressive disorder to those who did not.

Thirty-seven of the men (79 percent) had been diagnosed with major depressive disorder at the start of the study, compared to ten men (21 percent) who did not have it.

During the program, the men participated in 90-minute group sessions and 60-minute individual sessions twice a week with cognitive processing therapy.

In addition, they were encouraged to attend a range of other group sessions available each week focusing on topics like anger management, preventing a relapse, communication and behavioral therapy.

They also attended individual speech and cognitive therapy three times a week to improve memory, attention and their executive function (brain) abilities.

Those who were designated as needing medication also received medication management.

Before the study, the veterans with major depression in addition to PTSD and TBI reported much worse symptoms on their conditions.

After the study, self-reported symptoms decreased significantly for all the men for PTSD and for major depression.

While those with depression reported more severe symptoms each time they were assessed, the reduction in their symptoms was about the same as the reduction in those without depression.

"The groups comparably benefited in terms of no longer meeting full diagnostic criteria for PTSD following treatment," the authors wrote.

Therefore, having major depression did not prevent the men from benefiting from the PTSD and TBI treatment. Further, over half of those admitted to the program with major depression no longer had it when they completed the program.

The study's biggest limitation is that the men participated in a residential program, so outpatient programs may not show the same effect.

However, all the men in the program, regardless of whether they had major depression or not, experienced a fewer PTSD symptoms.

The study was published in the August issue of the Journal of Traumatic Stress. Information was unavailable regarding funding and disclosures.

Reviewed by: 
Review Date: 
September 26, 2012
Last Updated:
September 27, 2012