Leo Sher
Columbia University and New York State Psychiatric Institute, New York, New York, USA
Internet and Suicide. Hauppauge, New York: Nova Science Publishers, 2009, 452 pages.

Post-traumatic stress disorder (PTSD) is a common psychiatric disorder. PTSD is frequently comorbid with major depressive disorder (MDD). I have previously proposed that some or all individuals diagnosed with comorbid PTSD and MDD have a separate psychobiological condition that can be termed “post-traumatic mood disorder” (PTMD). The suggestion was based on the fact that a significant number of studies suggested that patients suffering from comorbid PTSD and MDD differed clinically and biologically from individuals with PTSD alone or MDD alone. Individuals with comorbid PTSD and MDD are characterized by greater severity of symptoms and the higher level of impairment in social and occupational functioning compared to individuals with PTSD alone or MDD alone. Neurobiological evidence supporting the concept of PTMD includes the findings from neuroendocrine challenge, cerebrospinal fluid, neuroimaging, sleep and other studies. The wars in Iraq and Afghanistan have presented Soldiers and Marines with a unique set of stressors that are chronic in nature, including civilian threats such as guerilla warfare tactics and terrorist actions. Many returning war veterans suffer from comorbid PTSD and depression, i.e., they have PTMD. PTMD is associated with suicidal behavior. It is important to develop interventions to prevent PTMD in war veterans, measures to prevent suicidal behavior war veterans with PTMD, and to study psychobiology of PTMD in order to develop treatments for PTMD. Priorities for intervening to reduce suicidal behavior in war veterans lie with interventions focused upon the improved recognition, treatment and management of veterans with psychiatric disorders including PTMD. Possibly, Internet based self-management programs may help to treat mental health problems in war veterans.