The concept of posttraumatic mood disorder and its relation to suicidal behavior in war veterans

Leo Sher
Columbia University and New York State Psychiatric Institute, New York, New York, USA
War and Suicide. Hauppauge, New York: Nova Science Publishers, 2009, 306 pages.

Individuals exposed to severe traumatic stress often develop comorbid posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). I developed a new concept suggesting that 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). This concept is supported by a significant number of clinical, translational and other studies suggesting that patients suffering from comorbid PTSD and MDD are different clinically and biologically from individuals with PTSD alone or MDD alone. Patients with comorbid PTSD and MDD are characterized by greater impairment compared to individuals with PTSD alone or MDD alone. Neurobiological evidence supporting the concept of PTMD includes the findings related to dopaminergic, serotonergic, and hypothalamic-pituitary-adrenal axis function and other observations. Combat-related trauma may result in PTMD. The wars in Iraq and Afghanistan have presented coalition soldiers with a unique set of severe and chronic stressors. Many returning war veterans suffer from comorbid PTSD and MDD (i.e., PTMD) and exhibit suicidal behavior. Both PTSD and MDD are associated with suicidal behavior and there are observations suggesting that individuals with comorbid PTSD and MDD (i.e., PTMD) have higher suicidality compard to persons with MDD only. It is crucial to develop interventions to prevent and to treat PTMD in war veterans and measures to prevent and to treat suicidal ideation and behavior in war veterans with PTMD