FORT BLISS, Texas -- Depression and anxiety can feel like a misery that will never end.

Vicki Thomas, Ph.D., chief of the Fort Bliss Warrior Resilience Center, believes that it is virtually impossible to have post traumatic stress disorder without depression. At the WRC, Soldiers are treated for moderate to severe Post Traumatic Stress Disorder.

"It is depressing to know you are overreacting to things, to not feel in control of your anxiety and behaviors," she said.

Thomas's comments echo findings from countless studies showing that people with PTSD are at much greater risk for developing a number of other behavioral health disorders, such as anxiety and depression.

"Actually, depression and anxiety are flip sides of the same coin. They might seem like opposites, but they often occur simultaneously," Thomas said.

She added that the hyper vigilance -- being constantly alert and constantly on guard -- of PTSD results in feelings of loss of control. Loss of control causes anxiety for the PTSD sufferer. On the flip side, depression results from not being able to regain that control.

The hyper vigilance of PTSD, along with other symptoms of PTSD can be so distressing and debilitating that depression develops.

People with PTSD feel detached or disconnected from friends and family. They find little pleasure in activities they once enjoyed. Finally, they may even have difficulty experiencing positive emotions such as joy and happiness.

Isolation develops as they avoid engaging, particularly in activities that might trigger memories of the traumatic event or event that triggered the PTSD.

"It's depressing to deal with avoidance behaviors in an attempt to stay away from things that remind you of - or make you feel the way you did during - the worst event of your life, Thomas said.

"If our sense of 'I can handle this' is missing, it can result in anxiety for one person and depression for the other. Either they shut down or go on all points alert."

Thomas added that depression can lead to other medical conditions for the PTSD sufferer.

"Mind and body are not separate -- they interact all day," she said. "Our mental state affects the immune system, the ability to focus, in fact every bodily system is at a higher vulnerability."

Depression sufferers may bottom out and stop moving. When people stop moving the body's function is compromised. In the deepest depths of depression, people don't have enough energy to get out of bed.

"In the Army, Soldiers don't have that option. They are forced out of bed -- to mimic a life with some accountability and productivity, Thomas said.

"There is no energy source within the Soldier which manifests in anger and irritability. Depression occurs as a result of forcing ourselves to do what the heart just cannot engage in."

Thomas scoffs at the idea of depression "being all in your head." "That makes it sound like it is not real. Anyone who has experienced depression knows that it aches, it feels, it is real," she said.
In the treatment program at WRC, Thomas focuses on the anxiety issues associated with PTSD. She has found that once the anxiety improves, the depression lifts as well.

"Relationships come back online and work again for the Soldiers," Thomas said. "They are able to engage in their lives again, and see a way forward."

Thomas tells Soldiers to face down their behavioral health issues. "Struggling and overcoming our problems makes us stronger," she said.

"I ask them to reach out to someone else they see struggling, and tell them -- I've been there."