Feb 23rd 2023
Major depression and situational depression are both mental health conditions characterized by persistent feelings of sadness and loss of interest in activities. While the disorders are similar, there are some key differences in symptoms, causes, and treatment options that are important to understand.
A diagnosis of major depressive disorder can be made if at least five of the following DSM criteria are met. At least one of those must be from the first two criteria:
These symptoms must last at least two weeks and cause significant impairment in daily functioning.  They also cannot co-occur with any manic or hypomanic episodes.
Situational depression, clinically known as adjustment disorder with depressed mood, is when an individual shows signs of depression following a stressful life event or circumstance. Stressors can include things like illness, financial difficulties, job loss, or relationship difficulties. 
Adjustment disorder is one of the most common diagnoses in clinical settings, affecting up to 20% of those in outpatient care and up to 50% of those in inpatient settings. 
A diagnosis of adjustment disorder can be made if the following DSM criteria are met:
The specification “with depressed mood” is diagnosed when the symptoms predominantly include feelings of hopelessness, low mood, and tearfulness. 
The DSM specifies that stressors can be recurrent, continuous, or one-time events. Any diagnosis of adjustment disorder needs to take cultural differences into account when determining what counts as an extreme reaction to a given stressor. 
Major depression and situational depression share many of the same symptoms. Patients with either disorder may experience the following symptoms:
The most important differentiators between the two are whether the onset was precipitated by a stressor and whether symptoms end after the stressor is removed. MDD is not necessarily tied to a particular stressor and there is not always a known trigger.
Neither disorder has a single known cause. Still, psychologists have different theories of what contributes to each type of depression.
There is no well-understood cause for major depression. However, it is believed to be the result of a combination of biological and environmental factors.
MDD has been linked to an imbalance of chemicals in the brain. Abnormalities in GABA, serotonin, dopamine, and norepinephrine have been found in depressed patients.  These neurotransmitters all help regulate mood.
Trauma and negative childhood experiences also have a role in the development of MDD.  In fact, early stressful experiences have been found to cause significant changes to the brain structure, which can increase the risk of clinical depression later in life. 
Although situational depression is known to be triggered by current stressors, it is not fully understood why some people are more susceptible to this stress response than others.
Experts theorize that social skills and coping skills developed earlier in life play a part in determining one’s reaction.  An individual’s innate temperament also plays a role.  Finally, some genes have been identified as increasing one’s vulnerability to stress. 
Due to the different nature and duration of the disorders, different treatments are recommended for each. However, both types of depression can benefit from psychotherapy and lifestyle changes.
Major depression is treated primarily through psychotherapy and medication. Research has found that combining the two is more effective than either form of treatment on its own. 
The most commonly used forms of therapy for MDD are interpersonal therapy and cognitive-behavioral therapy (CBT).  The focus is on changing distorted thought patterns, which can contribute to a depressed mood.
Other antidepressants include tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), serotonin modulators, and atypical antidepressants. 
If a patient’s MDD is severe or resistant to treatment, electroconvulsive therapy (ECT) may be effective.  This procedure involves inducing a seizure, which, for unknown reasons, helps to improve symptoms. 
Lastly, certain lifestyle changes can help to improve daily functioning. These include exercising, eating healthy meals, avoiding alcohol, and sleeping better.  Mindfulness and meditation techniques can also help the patient to manage symptoms.
By definition, situational depression resolves on its own once the stressor is removed. However, when the stressor is longer-lived or the symptoms are severe, treatment can help make life more manageable.
The preferred treatment is psychotherapy, and, similar to MDD, interpersonal therapy or CBT are preferred.  Both can help patients learn coping skills that can mitigate the effects of the stressor.
Similar to MDD, lifestyle changes and mindfulness routines can be beneficial in improving quality of life.  They can also help patients to manage future stressors.
Medication is usually not recommended unless symptoms are severe or there is suicidal ideation. 
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