Depression is one of the world’s top public health problems, and it affects approximately 7% to 12% of men and 20% to 25% of women across their lifetime (Kessler, 2003). While depression may not be commonly associated with traumatic experiences such as combat, rates of depression in our servicemen and women are not insignificant. Hoge et al., (2004) found rates between 14% and 15% in soldiers and Marines 3 to 4 months after deployment to Iraq or Afghanistan. These findings are consistent with the rate of 14% identified in individuals after they had served in Iraq or Afghanistan (RAND Report, 2008). Some military personnel struggle with depression irrespective of a deployment. In veterans seeking care at VA hospitals, depression presents at an even higher rate -- about 25% -- either alone or along with conditions like PTSD and substance use (OIF & OEF Deployment Roster, VA Healthcare, 2008).
A depressive episode is characterized by a number of symptoms, perhaps the most obvious being depressed mood most of the day, every day. However, depressed mood is not required for a person to be experiencing a depressive episode. Instead, a person may manifest anhedonia (lack of interest/pleasure) or irritability as their primary depression symptom. Additionally, a depressive episode may include disruptions in sleep, excessive or inappropriate guilt, decrease energy, decreased concentration, changes in appetite, psychomotor changes, and/or thoughts of death.
Red flags for depression may include chronic illness, decreased function, history of abuse or neglect, family history of depression, significant losses and other psychiatric problems (VHA/DOD Clinical Practice Guideline for MDD, 2000). Additional risk factors for military personnel, as identified by a RAND Report (2008) include: no longer active duty (e.g., Reserve Component); older age; enlisted personnel; female; Hispanic; more lengthy deployments and greater exposure to combat to trauma. A thorough suicide risk assessment should be conducted carefully if an individual endorses suicidal ideation.
PTSD and depression share many symptoms in common, such as sleep disturbance, anhedonia and irritability. Reexperiencing symptoms like flashbacks and physiological reactions to triggers can distinguish PTSD from depression. At the same time, comorbidity rates of PTSD and depression are high, so both conditions may be present.
Fortunately, depression is a treatable disorder. Empirically-validated treatments recognized by the VHA/DOD Clinical Practice Guideline for the Management of MDD (2000) comprise of cognitive therapy, behavioral therapy, interpersonal therapy, marital therapy, and medication. Cognitive-behavioral therapies and interpersonal therapy have received the strongest research support in terms of effectiveness. The combination of psychotherapy and medication, when needed, has been shown to be effective for treating depression.