Depression or Trauma?

For much of my adult life, I’ve thought of myself as having repeated episodes of depression, or perhaps a kind of chronic depression that gets a bit better and then a bit worse, in an ebb and flow that has felt unpredictable. I’ve taken many different meds, and at times I’ve felt a little better, only to slip back into more of the same. Sometimes I have thought, “maybe this is what they mean by treatment-resistant depression.” The diagnosis has usually been Major Depressive Disorder, recurrent, severe, without psychotic features. Some of the time, depending on the practitioner I’ve been working with, I’ve also had a diagnosis of “maybe some PTSD,” as E put it one time.

I don’t think that anymore. Now I think I have been suffering from unresolved complex trauma. Yes, I have been depressed a lot of the time. But treating the depression alone would never make me feel better, because the trauma causes the depression. As long as it isn’t addressed, the depression can’t really go away.

Why, I wonder, has it taken me so long to understand this?

At one level, I suppose I knew it. That’s why I kept working with E, my therapist, on bringing the things I remembered with horror and shame out into the light, as painful and difficult as that was. Some part of me must have known that this would eventually feel liberating.

Still, for the most part, I felt like I needed depression treatment, and I focused a lot, too much I now believe, on anti-depressants. I talked about “managing my chronic depression” by reducing stress, exercising when I could, and eating a healthy diet with plenty of omega three. I went to lots and lots and lots of talk therapy. Not that this was bad or foolish. But I don’t think that it would ever get me to a state of wellness.

What’s helped the most, I think, are the approaches that are now getting a lot more attention in research on trauma: mindfulness and body-based approaches. I wish I had seen the trauma as my primary challenge and focused on treating it, especially with the treatments coming out of recent brain and body research. Learning to identify emotions and sensations in the body, and more than that, learning to tolerate them rather than dissociating–this has been transformative for me.

I had a conversation with my friend Polly about this recently. As much as I feel I’ve suffered from trauma and depression, my journey looks like a long picnic compared to what Polly’s gone through. The severity of her symptoms destroyed her career, leaving her in precarious financial circumstances. She’s found little relief from medications, and only a little from ECT. Losing several jobs has left her both angry and demoralized.

Over the past two years, however, she’s come to the same conclusion that I have: her depression is secondary to her childhood trauma, and treating the aftermath of trauma directly is a thousand times more effective than repeated attempts to simply treat depression. After thirty years of suffering, she is finally, finally starting to feel better. But what a toll it’s taken.

I don’t know if things could have been different for me or my friend. I don’t know that there were enough therapists with a good understanding of trauma treatment back when Polly and I were first trying to get help. I’m relieved though that the field is shifting and encouraged about the spread of knowledge about trauma treatment.

I’ve been watching the recent webinars put on by the National Institute for the Clinical Application of Behavioral Medicine (NICABM) on treating trauma and found them to be extremely informative. Apparently more than 36,000 people from 124 different countries have been tuning in to the five-part series. This encourages me, makes me hopeful. Maybe future generations won’t spend decades on treatment that doesn’t address the primary problem. Wouldn’t that be amazing?

CREDIT: Photo by Nathan Fertig on Unsplash 

3 comments

  1. Hi Q. I read your other blog back in the day and missed it when you went private. I’m glad to see you online and writing again. I very strongly resonate with your insights re: depression as secondary to unresolved complex trauma. This was a powerful revelation that I finally grasped a few years ago and it has transformed my understanding of myself. I wish you the best on your healing journey. Thank you for sharing your writing with the world.

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    • Hi Empress! Thank you for your kind comment. That’s validating to hear that you came to the same conclusion about the relationship of your depression to your trauma. Has it changed the kind of treatment you’ve sought as well? Wishing you well, Q.

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      • Thank you for replying to my comment! It was about two years into my treatment with my therapist—who serendipitously specializes in trauma, although that’s not why I chose him—that I finally accepted what he’d been encouraging me to accept: the primary source of my suffering was trauma. Complex trauma, in fact, which was not terminology I’d ever heard before. He had been telling me for quite some time that I has having normal reactions to abnormal things that happened to me, and avoiding avoiding was the only way out of hell. His approach is also DBT-infused (we’re not doing true DBT, and I don’t have borderline) so there’s lots of encouragement toward opposite action, approaching instead of avoiding, etc. He did not invalidate my decades of depression and anxiety, but instead helped me reframe and recontexualize that.

        He had brought up EMDR more than once, but I was resistant to it, due to a negative experience with it with a previous therapist who was not that experienced with it. But finally, I was wiling to approach EMDR with him. That has been transformative. I go twice a week, and typically we do one day of EMDR, and the other day is post-EMDR processing, and talking other stuff (like daily life whatevers.)

        It’s been slow-going. When I read about EMDR online it seemed like a really fast process. It’s not with me. But it works. I’ve processed two major traumas thus far, and now they are distant bad memories, like looking at an ugly painting on the wall without my glasses on, instead of feeling like they are happening now, in my body, with everything on fire.

        Another key thing about my treatment is that my therapist is a straight man around my own age (I am an early 40s queer woman), which normally is like WHOA DANGER ALERT AVOID AVOID, so there’s corrective emotional experience stuff happening here. We’re approaching four years of working together now. It is changing my life.

        This has turned into a long comment! Apologies for my long-windedness. Hope this is helpful in some way.

        Liked by 1 person

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