Virtually no one gets through life without experiencing some kind of trauma. Whether it’s a violent act, a natural disaster, a divorce or a death, we all struggle to regain our footing after an initial shock.
If you live with a mood disorder (depression or bipolar disorder), a traumatic event can disrupt your routine and impact your therapy. It may even trigger an episode of mania or a deepening of depression. Those that already have a strong support system and routine in place will find themselves relying on those connections regularly. Keep in mind that it’s crucial to share thoughts and impressions with trusted friends, family members, healthcare providers and your CBT support group. Know, too, that severe emotional responses constitute a normal part of the healing process.
Normal Feelings You May Experience After a Traumatic Event
After a trauma, you may experience any number of the reactions below. People are affected differently at different times and there is no “normal” way to respond. Don’t be surprised if you’re experiencing:
feelings of disconnection or emotional flatness, numbness
extreme sadness, crying
vacillating emotions – shock, denial, guilt, self-blame, anger, elation
vacillating moods – irritability, anxiousness, nervousness, pessimism, indifference
recurring memories or dreams about the event
excessive consumption of alcohol
unexplained aches and pains, nausea, fatigue, low energy
changes in eating habits or sleep
loss of focus
Can Someone with a Mood Disorder Also Develop Post-Traumatic Stress Disorder?
Anyone, no matter their mental or physical health, can experience post-traumatic stress disorder (PTSD). Those with mood disorders may even find their lives even more disrupted than usual.
Full-blown post-traumatic stress disorder tends to begin within the first three months following the event. Sometimes, however, six months pass before an individual begins exhibiting symptoms. Half of those stricken with PTSD recover within three months.
Those who can’t shake the symptoms for over a year must receive treatment if they want to improve.
Those with clinical PTSD typically:
have experienced an immediate response to a traumatic event
reacted with extreme fear, horror and/or helplessness to the event
continually re-live the event (“flashbacks) through dreams, hallucinations and images
try to escape anything that would remind him or her of the event
demonstrate some apparent memory loss about the event
experience increased irritability, anger, difficulty sleeping or concentrating
sense heightened awareness, over-reacts when startled, feels overwhelmed by impending doom or danger
struggle at work and in relationships for one month or longer
Some form of these symptoms occur in nearly everyone exposed to a devastating event. If an individual recovers from them in four weeks or less, doctors consider them to have experienced a milder form of PTSD known as “acute stresss” disorder.
A significant number of trauma survivors, however, cannot defeat these symptoms within a useful time period. If you experience these symptoms in addition to exacerbated symptoms from your mood disorder for longer than three months, it’s imperative you discuss your situation with your healthcare providers
How Does PTSD Impact Depression and Visa Versa?
Depression is commonly found in people diagnosed with PTSD. According to the National Institute of Mental Health, depression occurred in 40% of PTSD patients one to four months after the event. The good news is that both PTSD and depression respond well to medical and talk therapy treatment, particularly if they are caught early.
Can a Trauma Cause Depression?
Studies show that trauma can change the actual chemistry in the brain. In fact, a severe external event can bring on depression. Further, any previous trauma you’ve experienced can impact (worsen) your current reaction.
Most people treated for depression with medication and therapy respond well. In fact, a significant number need only take medication for a year or less. While in decades past, some resisted taking medication for depression, research studies (and studies of research studies) have proven conclusively that depression is a treatable medical illness. If your symptoms persist, seek a doctor’s help and do not fear any stigma involved with treatment.
Can’t I Just Get Over PTSD on My Own?
As much as we think we can control our thoughts and therefore our moods, trying to just give your mood time to recover on its own can lead to an intensification of mental and physical illness. Ignoring any flashbacks or disturbing moods, rather than helping the situation, compounds your distress, whether you acknowledge that distress or not.
Even though talking about your experiences surrounding the event can cause pain and a resurgence of fear and other uncomfortable feelings, treatment will ultimately bring great relief. Your symptoms can be treated using the three approaches discussed above. If your symptoms continue, they will eventually interfere with your work and relationships. Your quality of life will suffer. People who try to deal with the problem alone usually fail.
Some individuals who’ve experienced trauma even begin having thoughts of suicide. Don’t wait for these symptoms to become so severe that a crisis occurs. If you or a friend or relative is having thoughts of death or suicide, contact a doctor, a therapist, a trusted clergy member or friend. You can also call the suicide crisis hotline at 1-800-273-8255 (TALK). Getting an opinion other than your own could save your life and save your family great suffering.
Why Can’t I Recover Faster?
The days are long past now when well-meaning relatives tell you to “pull yourself out of it” or “toughen up” in the days following a trauma. Most are familiar with the term “grief counseling” and “post-traumatic stress disorder.” After every plane crash and earthquake, the news programs interview the psychologists assigned to help the survivors. The number one mistake those who experience trauma make is having unrealistic expectations that they should be back on their feet or “back to normal” faster than their psyche allows. Grief is a necessary process of recovery. Those who seem to have recovered fast usually haven’t recovered at all. Their reluctance to deal with their feels of fear, anger, sadness and loss now will fester and either emerge down the line or erupt in inappropriate ways.
What Steps Can I Take to Recover from Trauma?
- Limit your Exposure to the news if the trauma involved a matural disaster constantly being televised.
- Keep your daily routine.
- Contact Alcoholics Anonymous or Narcotics Anonymous or a trusted friend if you find yourslf relying on alcohol or illegal drugs.
- Eat balanced meals, get regular esercise and lots of rest.
- Make sure you take any prescribed medication.
- Attend ny support groups. Get our with others who've had the same experience. Make sure to discuss things other that the event, however.
- Do things you enjoy. Gardening, listening to music, reading, playing with childdren, doing a hobby can help you realize the positive aspects of your life.
- Focus all your energy on the event, gathering an abundance of facts and anecdotes. Make it the center of all your conversations.
- Make any major life decisions, like divorcing or selling a home.
- Start thinking alcohol or illegal drugs will help you handle the stress.
- Isolate yourself.
- Watch disturbing news shows right before going to bed.
People survive and even grow in the aftermath of shocking, horrible events. The prime directive is to allow yourself to feel your grief, fear and other emotions, rather than shutting yourself off to them. By taking some specific steps, you avoid letting depression and shock overwhelm your life.
The Healthcare Approach to Treating Trauma-Induced Depression
Beyond the steps listed above, if your depression persists for two weeks or more following a catastrophic event, healthcare professionals in the United States today typically recommend a three-pronged approach to effective recovery.
Medication: In the past two decades, drug companies and other institutions have been developing medications that are more and more effective and specific. These medications work either singly or in concert to bring unbalanced brain chemicals back to optimal levels. Currently, millions of Americans take medications that affect mood. In fact, in some cities, so many people are taking prescription Prozac that water department officials can detect it in the water supply!
Therapy: Where medication targets mood, talk therapy targets behavior. Studies have proved that therapy can be quite effective. In fact, therapy has brought some out of depression without the help of medication at all. Doctors agree, however, that talk therapy works best when the patient uses even a small amount of medication as well. Therapists help individuals learn coping strategies, educate them about how others react to trauma and help them see which of their behaviors works and which don’t. Mood elevates as the motivated client makes positive behavioral changes. The support the therapist provides also reduces the patient’s stress, improving brain chemistry.
Support Groups: While attending a support group may not seem like serious medicine, serious researchers have found that many of those who attend support groups report more of an improvement in symptoms and mood those who don’t.
Because of differences in physical make-up and temperament, every individual will respond to the three approaches differently. Using all three in concert can, however, will increase the odds that you’ll cover all the factors contributing to low mood.
How Do I Help a Loved One Cope After Trauma?
First, if you’ve experienced the same trauma, be sure to treat your own depression or stress before you extend too much of yourself to another. On the other hand, if the trauma didn’t involve you or you’ve recovered more quickly, your help will be indispensible to a loved one. Here are some dos and don’ts for helping another.
- Realize another’s reaction may not be the same as yours.
- Try to understand unique experiences and responses.
- Watch for signs of stress a loved one may exhibit.
- Allow them to express their feelings honestly.
- Invite them for walks, outings, lunches and other activities.
- Try to be patient.
- Accompany your loved to doctor’s appointments if need by.
- Take remarks about suicide seriously. Have suicide hotline numbers available for yourself and the affected person.
- Tell another his or her reaction is abnormal or problematic in any way.
- Tell the individual to “get on with your life” or that “things could have been worse.” Even “it was God’s plan” could be construed as insensitive.
- Hesitate to suggest a doctor if you think your loved one needs treatment.
- Ignore threats of suicide. Those who threaten often attempt.
How Can I Help a Child Affected by Trauma?
Because of their innocence, it can be doubly sad when a child experiences trauma. Adults typically have more experience and coping skills to handle trauma. Children are often confused and frightened on top of being depressed when a shocking event occurs. Further, because they have little power in their daily lives, anxiety about what could happen next may overwhelm them.
Know first that children are not usually as aware of or able to express their feelings as easily and clearly as adults. Prepare yourself for unusual behavior like acting out or shutting down. Don’t get caught up in panic that the child has changed forever or that others will think the child’s negative behavior reflects on you. Unusual behavior is normal and to be expected. Try to be patient and understanding. Post-trauma is an unusual period and with time most recover.
- Help them talk about their feelings.
- Impress upon them that there are no bad or wrong feelings or emotions.
- Acknowledge and accept their sadness and/or anger.
- Keep a reasonable balance of discussing the situation and discussing other aspects of their lives.
- Reassure children that they are safe.
- Reassure children that adults are working hard to help the situation and make things right again.
- Reassure children that, while a terrible thing happened, they will be all right in the long run.
- Remind children that you love them and provide plenty of appropriate affection.
- Brainstorm ways children can help. Can they donate toys or clothes? Send cards?
- Call someone?
- Provide creative ways for children to express their feelings. Give them paper and pens and toys so that they can draw or act out feelings in non-verbal ways. Play with them.
- Spend time together in typical family activity. Find new family activities.
- Allow children much access to the television if the trauma is constantly televised in graphic images.
- Attempt to avoid discussing the situation.
- Depend on children for reassurance only adults can give.
- Hold angry discussions about who is to blame.
- Discuss retaliation for the event. Abandon all family routine.
What Does Depression in Children Look Like?
Children and adolescents can experience full-blown depression just like adults can. Their brains, however, are as yet very different from adult brain. While you may recognize some of the symptoms below as characteristics of adults, others belong only to young people. Be on the look out for:
change in eating and sleeping habits
loss of interest in friends
loss of interest in activities once enjoyed
excessive acting out
threats or thoughts of suicide
If these symptoms persist for two weeks or longer, consider talking about them with your family doctor. If he or she recommends a therapist, try to find one with plenty of experience with children your child’s age. The stages of child development vary drastically, and someone specializing in treating adolescents may not use strategies appropriate for younger children. Ask friends and others for a recommendation and remember that the right therapist for your child’s personality may take time to find. It is time well spent.
What Do I Do About My Post-Traumatic Suicidal Thoughts?
It’s common for those experiencing severe trauma to harbor suicidal thoughts. Despite how much you feel these thoughts and fantasies are based in reason, they are not. They are bio-chemical events, resulting from a chemical imbalance in your brain. They occur only because the neurotransmitters in your brain fail to occur at optimal or even reasonable levels. Once medications rectify this imbalance, suicidal thoughts disappear.
If you’re having suicidal thoughts, seek help right away. Even a call to your local suicide hotline can help you think through the irrational thoughts flooding your brain. Know, too, that almost everyone, at some point in life, has thoughts about suicide. You have no cause to feel shame for your feelings. Others can help you begin eradicating these thoughts from your daily life.
Tips for Addressing Your Own Suicidal Thoughts:
talk to a healthcare professional
talk to a trusted friend or family member
ask someone else to take away all weapons you could use to harm yourself
if suicidal feelings are particularly strong, get someone to take away your car keys, credit cards and check book
display photos of your favorite people or treasured events in your life
people want to help; let them; allow them to stay with you if you live alone
Guidelines for Dealing with Some Else Threatening Suicide:
Someone willing to speak about suicide has been thinking about it regularly. Take these comments seriously. Studies have shown that those that mention suicide often attempt or at least plan an attempt. Work up your courage and take the following steps:
inform the individual that you are going to take any suicidal statements very seriously and act accordingly
remove all weapons or potential weapons, including pills and alcohol
talk plainly to the individual about the effects of his or her suicide on loved ones
insist on a trip to the doctor or local clinic accompany the individual to the appointment
What If My Suicidal Loved One Won’t Listen to Me?
The guidelines above are great when you’re dealing with someone who values your opinion and responds to your support. Others are so ill that they cannot take any steps to help themselves and cannot accept help from others. They will isolate themselves. If this is the case and you truly fear an attempt may occur, you can still intervene.
Call 911 and inform the dispatcher that you fear this person may attempt suicide. Just sharing their suicidal statements is enough to get policemen to the individual’s door. You can also relate any plan details the individual may have shared with you and any availability of weapons or pills. The police will take the individual by force if need be to the local emergency room. Once a doctor provides a diagnosis, the police can then escort the individual to the county psychiatric unit for treatment.
Contrary to the image instilled by old movies and books, psychiatric units treat their clients with compassion and integrity. Run by doctors and oversight committees, they are clean and organized. A stop at the psychiatric unit may be just the wake up call your loved one needs to convince him or her that doctors really can help.
• International Society for Traumatic Stress Studies (ISTSS) 60 Revere Drive, Suite 500, Northbrook, IL 60062. (847) 480-9028 www.istss.org
• National Center for Post Traumatic Stress Disorder (802) 296-5132 www.ncptsd.org
• Sidran Traumatic Stress Foundation (410) 825-8888 www.sidran.org
• PTSD Alliance (877) 507-PTSD (7873) www.ptsdalliance.org