Understanding PTSD and Depression After Trauma and How to Get Help

Definition and diagnostic criteria

Posttraumatic Stress Disorder (PTSD) is a trauma- and stressor-related disorder. It can develop after exposure to actual or threatened death, serious injury, or sexual violence—whether directly experiencing it, witnessing it, learning about it happening to a close person, or repeatedly experiencing exposure to details of the event (such as first responders). Depression can occur as a separate mood disorder (major depressive disorder) or as persistent depressive symptoms that accompany PTSD.

Diagnostic criteria for PTSD (summarized) commonly follow these clusters:

• A. Exposure: Direct exposure or witnessing, learning that a violent or sexual trauma happened to a loved one, or repeated exposure to details of the event.
• B. Intrusion Symptoms: Distressing memories, recurring dreams, flashbacks, intense emotional or physical reactions to reminders, or distress at reminders.
• C. Avoidance: Avoiding memories, thoughts, feelings, or external reminders of the trauma.
• D. Negative alterations in cognitions and mood: Inability to recall aspects of the event, persistent negative beliefs, distorted blame, persistent negative emotional state, diminished interest, detachment, or inability to experience positive emotions.
• E. Arousal and reactivity: Irritable or angry outbursts, reckless or self-destructive behavior, hypervigilance, exaggerated startle, concentration problems, sleep disturbance.
• F. Duration: Symptoms persist for more than one month.
• G. Clinically significant distress or impairment: The symptoms cause functional impairment in work, relationships, or other important areas.
• H. Exclusion: The disturbance is not attributable to substances or another medical condition.

For children and adolescents, some criteria appear differently, and clinicians adapt questions to developmental levels. A professional evaluation considers the full range of symptoms, how long they’ve lasted, and the impact on daily life.

Symptoms and signs

PTSD symptoms tend to fall into four groups, which may overlap with depressive symptoms:

• Intrusive memories, distressing dreams, flashbacks, or strong emotional or physical reactions to reminders.
• Avoiding thoughts, conversations, places, or people related to the trauma; feeling detached from others; reduced interest in activities; numbness or a sense of foreshortened future.
• Ongoing fear, anger, guilt, shame, blame of self or others; decreased participation in activities; persistent negative beliefs about oneself or the world; inability to recall aspects of the event.
• Sleep problems, irritability or aggression, difficulty concentrating, hypervigilance, exaggerated startle response.

Depression-related signs can accompany PTSD or stand alone as a separate diagnosis. Common depressive symptoms include persistent sadness or emptiness, loss of interest in most activities (anhedonia), fatigue, changes in sleep or appetite, feelings of worthlessness or excessive guilt, trouble concentrating, and thoughts of death or suicide.

Causes and risk factors

PTSD and depression after trauma arise from a mix of factors that differ by person and situation. Not everyone exposed to trauma develops PTSD, but certain factors raise risk:

• More severe or prolonged trauma, especially interpersonal violence or sexual assault, increases risk.
• A history of anxiety, depression, or other mental health conditions can raise the likelihood of developing PTSD or depressive symptoms after trauma.
• Genes involved in stress responses and the functioning of the brain’s fear circuitry (amygdala, hippocampus, prefrontal cortex) can influence vulnerability.
• Chronic sleep problems, chronic pain, or other medical conditions can worsen symptoms and complicate recovery.
• Strong social support and access to care promote resilience; ongoing adversity, isolation, or poverty increase risk.
• Children, adolescents, and older adults may show different symptom patterns and require developmentally tailored care.
• Substance misuse can worsen PTSD and depressive symptoms and interfere with treatment.

Protective factors, such as trusting relationships, early intervention after trauma, and engagement in meaningful activities, can help reduce the impact of PTSD and depression.

How it is diagnosed by professionals

A thorough assessment is essential. Mental health professionals use clinical interviews, standardized questionnaires, and, when appropriate, structured interviews to determine whether PTSD symptoms meet criteria and whether depressive disorders are present.

• A clinician asks about trauma exposure, symptom duration, intensity, and functional impact, and screens for safety concerns.
• Tools such as the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) or self-report checklists (e.g., PTSD Checklist for DSM-5, or PCL-5) help quantify symptoms and track changes over time.
• Clinicians consider other conditions that can imitate PTSD or depression (e.g., bipolar disorder, generalized anxiety disorder, adjustment disorders, substance-induced symptoms) and assess for medical contributors (thyroid issues, sleep apnea, neurological conditions).
• For children and adolescents, assessment tools and questions are adapted to their stage of development and family context.

Treatment approaches and options

The strongest evidence supports a combination of psychotherapies focused on trauma and, when needed, medications to address PTSD symptoms and co-occurring depression.

Psychotherapy (talk therapies)

• These therapies help reframe distorted beliefs about the trauma, reduce avoidance, and improve coping skills. Typical courses are structured over several weeks.
• Gradual, controlled exposure to trauma memories and reminders to reduce avoidance and fear responses. Conducted with trained therapists to ensure safety and pacing.
• A structured therapy that uses guided eye movements or other bilateral stimulation to process trauma memories and reduce their emotional impact.
• General CBT, mindfulness-based therapies, and family or group therapies can support recovery, especially when tailored to the individual’s needs and cultural context.

Medications

• First-line pharmacotherapy: Selective serotonin reuptake inhibitors (SSRIs) such as sertraline or paroxetine are commonly used and may help with both PTSD and co-occurring depressive symptoms. Serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine may also be used.
• Medications may be chosen to address anxiety, sleep disturbances, nightmares, or depressive symptoms, depending on the clinical picture.
• Medication usually works best when combined with psychotherapy. It may take several weeks to see benefit, and ongoing follow-up is essential to monitor effectiveness and side effects.

Additional considerations

• Sleep-focused strategies, including good sleep hygiene and, in some cases, targeted treatments for nightmares, can improve overall functioning.
• Addressing alcohol or drug use is important, as substances can worsen symptoms and interfere with treatment.
• If there is risk of self-harm or suicide, clinicians work with the person to create a safety plan and connect with crisis supports as needed.
• Telehealth, community-based programs, and culturally sensitive care improve access and engagement.

Prognosis and living with the condition

Prognosis varies with individual factors and access to effective care. Many people experience meaningful improvement with evidence-based therapies and supportive services; others may have a slower or more gradual course. Recovery does not always mean a complete absence of symptoms, but it often results in better functioning, improved relationships, and a higher quality of life.

Key factors that support a positive course include:

• Early engagement in assessment and treatment after trauma
• Access to evidence-based psychotherapy, with or without medication
• Strong social support networks and stable housing and employment
• Healthy routines around sleep, physical activity, and nutrition
• Management of co-occurring conditions, such as anxiety or substance use

Challenges that can slow progress include chronic stress, ongoing trauma or unsafe environments, stigma or untreated co-occurring conditions, and barriers to care. With sustained support, many people learn to manage symptoms, regain daily functioning, and pursue meaningful goals.

Support resources

If you or someone you know is in immediate danger or experiencing a crisis, call your local emergency number or the 988 Suicide & Crisis Lifeline in the United States at 988, or visit the Lifeline website for resources. For people outside the United States, many countries offer national crisis lines and mental health services; check local directories or contact a local healthcare provider for guidance.

The following organizations provide information, referral services, and support for PTSD and related depression. When you click a link, it will open in a new tab and includes an extra tracking parameter for this page.

• National Institute of Mental Health (NIMH) – PTSD — https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder?utm_source=lumair.ai (opens in new tab)
• American Psychological Association (APA) – PTSD — https://www.apa.org/topics/ptsd?utm_source=lumair.ai (opens in new tab)
• Mayo Clinic – PTSD symptoms and causes — https://www.mayoclinic.org/diseases-conditions/PTSD/symptoms-causes/syc-20355967?utm_source=lumair.ai (opens in new tab)
• VA National Center for PTSD — https://www.ptsd.va.gov/?utm_source=lumair.ai (opens in new tab)
• National Alliance on Mental Illness (NAMI) – PTSD — https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/PTSD?utm_source=lumair.ai (opens in new tab)
• International Society for Traumatic Stress Studies (ISTSS) — https://www.istss.org/?utm_source=lumair.ai (opens in new tab)

If you are seeking support for a loved one or yourself, these organizations can help with information, referrals to local clinicians, and education about evidence-based treatments.

Note: If you live outside the United States, you may find local crisis lines, mental health hotlines, or hospital-based services through national health ministries or local clinicians. A primary care physician or a licensed mental health professional can help you locate trauma-informed care in your area.