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"Situational depression", a colloquial term for mild depression with an obvious cause, isn't a diagnosis — but adjustment disorder with depressed mood matches the description closely. What are the symptoms, can it be prevented, and how is it treated?

Think "situational depression", and someone who's really down about something that's — let's face it — honestly pretty depressing comes to mind. Things like bereavement, job loss, a divorce or breakup, workplace harassment or for children being bullied, a natural disaster that made you lose your house (and we could go on almost endlessly) can easily turn your life upside down. Folks facing this kind of hardship understandably feel sad, down, angry, pessimistic, anxious, and lose interest in joy in many of the things that generally make life worthwhile. 

Do those kinds of symptoms point to a mental illness — which depression is — or are they simply a normal reaction to either normal but hard, or abnormal, situations? That's where things get interesting. Research dating back decades used the terms "reactive depression" or "situational major depressive disorder" to refer to clinical depression triggered by a particular stress or trauma, and debated whether this phenomenon differed from clinical depression in any meaningful way. 

Since then, we've learned a lot more about this phenomenon. Situational depression is now, in a way, a diagnosable form of depression — but it's not called that, and instead referred to as adjustment disorder with depressed mood. You may wonder how this differs from "just" grieving or being upset, with reason. 

Understanding the signs and symptoms of 'situational depression' — adjustment disorder with depressed mood

Adjustment disorders can, at their essence, be seen as "abnormal" or "excessive" behavioral reactions to recognized and identifiable stressors. That is, the affected people are mostly dealing with situations that are pretty universally considered stressful, but the diagnosing clinician thinks their reaction goes beyond what would be expected.

Besides "adjustment disorder with depressed mood" (situational depression, basically), it's also possible to have adjustment disorder with features of anxiety, a mixture of depression and anxiety, and some other kinds. 

Someone seeking help after having difficulty coping with a stressor may be diagnosed with adjustment disorder with depressed mood if:

  • They have symptoms of depression — feeling low, tearful, pessimistic, or hopeless much of the time. People have some of the other possible symptoms of major depressive disorder, like a loss of interest in daily activities, sleep trouble or oversleeping, appetite changes, and even suicidal thoughts, but don't meet all diagnostic criteria and can't better be diagnosed with that instead. 
  • The symptoms appear within three months of the stressful event happening, or stressful situation beginning. 
  • The symptoms have a significant negative impact on the person's daily functioning
  • The person feels better within six months of the end of the stressor or any consequences it had. 
  • Now for the subjective part — not only should the symptoms not be caused by another mental disorder (including a worsening of the symptoms of a preexisting mental disorder in reaction to the stressor), they shouldn't represent "normal bereavement" either. The clinician has to deem the symptoms "out of proportion to the severity or intensity of the stressor", but also take cultural factors into account during the diagnostic process — meaning that certain behaviors or feelings are considered disproportional in one culture, while totally normal in another.

The DSM-5, the current version of the Diagnostic and Statistical Manual of Mental Disorders, which clinicians are most likely to use to diagnose adjustment disorder, itself notes that what is and isn't considered normal in reaction to a stressor or loss varies from culture to culture. While demanding that clinicians consider this fact while diagnosing patients, we'll have to acknowledge that the diagnosis is somewhat subjective. 

What is situational depression not?

We've already established that adjustment disorder isn't simply normal grieving. Adjustment disorder with depressed mood cannot be diagnosed when a person meets the diagnostic criteria for major depressive disorder either, even if a clear stressor triggered this depression. This more severe kind of depression may still colloquially be called "situational depression", but clinically, it is a different beast. If you meet the diagnostic criteria, you'll be diagnosed with major depressive disorder instead.

A worsening of symptoms of a preexisting mental disorder — like bipolar disorder, schizophrenia, generalized anxiety disorder, or anything else — in response to trauma or stress also isn't adjustment disorder with depressed mood. 

Diagnosing doctors — and people themselves, if they happen to be exploring what they are dealing with on their own — should also consider that some of the events and situations that may trigger adjustment disorder can lead to post-traumatic stress disorder, too. PTSD can't be diagnosed until the symptoms have lasted at least a month, and features symptoms such as:

  • Hyper-vigilance
  • Intrusive thoughts and memories
  • Flashbacks (reliving the trauma)
  • Being easily startled
  • Avoiding things and places that may remind you of the trauma

Despite the differences, PTSD does have some things in common with depressive symptoms, in that people who live with it feel hopeless, pessimistic, and lose interest in activities that previously meant something to them. 

How is adjustment disorder with depressed mood treated?

While adjustment disorder is a common occurrence, there's no consensus when it comes to the most effective treatment approaches, in part because research is still lacking. This is in part due to the fact that the condition used to be considered self-limiting. Because adjustment disorder with depressed mood does increase the risk of suicide, however, more should be done than just "waiting it out".

People diagnosed with situational depression are perhaps most likely to be offered talk therapy — cognitive behavioral therapy or interpersonal therapy — and this approach has been found to help many patients recover faster. Patients may also be offered antidepressants, particularly if they have suicidal feelings. In this case, the same antidepressants that help those diagnosed with clinical depression will help — SSRIs such as sertraline (Zoloft) and citalopram (Celexa) may be prescribed. 

Who develops adjustment disorder with depressed mood, and can situational depression be prevented?

The DSM-5 suggests that the main risk factor for situational depression is environmental — people who have experienced a lot of stress in their lives may be more likely to develop it than others. Anyone who experiences a significant stressor can develop situational depression, however. Ways to minimize the possibility may include:

  • A strong social support network — having people to commiserate with and who will help you out may help you avoid sinking into depression
  • Good self-care — enough sleep, regular exercise, and allowing yourself to engage in activities you find enjoyable
  • Following a bereavement, you may also find it useful to see a therapist who can help you work through your thoughts and feelings, something that may prevent you from developing more severe symptoms

  • American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., (DSM-5). Washington, DC: American Psychiatric Publishing
  • 2013.
  • Photo courtesy of SteadyHealth.com

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