title: Depression sudden gains and transient depression spikes during treatment for PTSD.
abstract: OBJECTIVE
  We know little about how change unfolds in depression symptoms during posttraumatic stress disorder (PTSD) treatment or how patient characteristics predict depression symptom change. This study examined critical transition points in depression symptoms during PTSD treatment, namely, depression sudden gains, which are rapid symptom improvements and transient depression spikes, which are transient depression worsenings. Social support, one of the strongest predictors of PTSD development, was examined as a predictor of depression symptom discontinuities.
  
  
  METHODS
  At pretreatment, 200 participants (76.6% female; 64.9% Caucasian; age M = 37.1, SD = 11.3 years) completed measures of PTSD severity (PTSD Symptom Scale-Self-Report), depression severity (Beck Depression Inventory), general social support (Inventory of Socially Supportive Behaviors; Social Support Questionnaire), and trauma-related social support (Social Reactions Questionnaire). During 10 weeks of prolonged exposure (PE) or sertraline, depression was assessed weekly.
  
  
  RESULTS
  Overall, 18.0% of participants experienced a depression sudden gain, and 22.5% experienced a transient depression spike. The presence of a depression sudden gain predicted better treatment outcome, β = -4.82, SE = 1.17, p = .001, 95% CI [-6.79, -2.90]. Higher perceptions of negative trauma-related reactions, albeit modestly, were associated with experiencing a transient depression spike (r = .18, p = .01). There were no differences in rates of depression sudden gains or transient depression spikes between treatments.
  
  
  CONCLUSIONS
  Encouragingly, rapid improvements in depression symptoms are beneficial for PTSD treatment outcome, but transient spikes in depressive symptoms do not strongly influence outcome. Understanding symptom discontinuities may help us to personalize current PTSD treatment options.
authors.affiliation: Department of Psychological Sciences, Case Western Reserve University.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Keller
authors.affiliation: Department of Psychological Sciences, Case Western Reserve University.
authors.forename: Norah C
authors.initials: NC
authors.lastname: Feeny
authors.affiliation: Department of Psychology, University of Washington.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Zoellner
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D007171:Implosive Therapy; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D057566:Self Report; D020280:Sertraline / Q000627:therapeutic use*; D012720:Severity of Illness Index; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D011795:Surveys and Questionnaires; D063189:Symptom Assessment; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D020280:Sertraline