Posttraumatic stress disorder (
PTSD) frequently co-occurs with
major depressive disorder, and empirically supported
PTSD treatments consistently improve depression. However, both diagnoses are heterogeneous and specific patterns of symptom overlap may be related to worse treatment outcome. Two hundred individuals with chronic
PTSD participated in a doubly randomized preference trial comparing prolonged exposure and
sertraline. Latent Profile Analysis was used to identify classes based on
PTSD and depression symptoms prior to starting treatment. A three-class model best fit the data, with a high depression and
PTSD severity class (distressed), a moderate depression and low
PTSD avoidance class (depressive), and a low depression and high
PTSD avoidance class (avoidant). The avoidant class showed the lowest rates of
major depressive disorder diagnosis and transdiagnostic vulnerabilities to depression. Patients in the distressed class experienced more robust
PTSD treatment response, with no differences between prolonged exposure and
sertraline. These findings highlight the role of avoidance in nondepressed
PTSD presentations while also demonstrating that co-occurring depression is not contraindicated in evidence-based
PTSD treatment.