Clinical impact of comorbid major depression in subjects with posttraumatic stress disorder: A review of the literature

Nearly half of those with posttraumatic stress disorder (PTSD) have co-occurring major depressive disorder. Some etiopathogenic theories and treatments have been postulated for this comorbidity. However, there are no systematic reviews aimed at addressing the clinical impact of comorbid major depression in the PTSD profile. A comprehensive database search was performed from 1985 to February 2015. Overall, 94 studies fulfilled the inclusion criteria. The main evidence is described concerning several clinical criteria: PTSD symptoms and other psychopathology (suicide ideation/attempts or/and alcohol misuse), disability (quality of life and/or medical conditions), natural course, and treatment-related features (treatment seeking, response to treatment, and/or treatment compliance/preference). Overall, comorbid major depression tends to exert a deleterious role on the PTSD profile. This negative effect is mainly found regarding the symptomatology, disability, and natural course of PTSD. Methodological divergences are discussed with respect to inconsistent findings.