Major Depression vs Situational Depression

What is major depression?

Major depressive disorder (MDD) is a mood disorder characterized by a continuous low mood. In any given year, 7% of individuals will be affected by this mental illness. ^[1]

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:

• Depressed mood most of the day, almost every day. In children and adolescents, this may manifest as an irritable mood instead.
• Loss of pleasure or interest in most activities all day, nearly every day
• Weight loss (when not trying to lose weight) or gain of 5% or more, or significant increase or decrease in appetite
• Significant increase or decrease in sleeping
• Observable restlessness or moving more slowly than usual
• Loss of energy or fatigue
• Feelings of guilt or worthlessness
• Indecisiveness or lower ability to concentrate
• Recurring thoughts of death or suicidal ideation ^[1]

These symptoms must last at least two weeks and cause significant impairment in daily functioning. ^[1] They also cannot co-occur with any manic or hypomanic episodes.

What is situational depression?

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. ^[7]

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. ^[1]

A diagnosis of adjustment disorder can be made if the following DSM criteria are met:

• Behavioral or emotional symptoms that developed as a result of an identifiable stressor or stressors. These symptoms occur within three months of the start of the stressors.
• These symptoms are characterized by at least one of the following: 1.) a level of distress that is considered extreme relative to the severity of the stressful event or 2.) significantly impaired functioning in social, occupational, or other important life settings.
• Symptoms do not meet the criteria for another disorder and are not simply worsened from an existing disorder.
• Symptoms are not characteristic of normal bereavement.
• Symptoms cease within six months after the stressor concludes. ^[1]

The specification “with depressed mood” is diagnosed when the symptoms predominantly include feelings of hopelessness, low mood, and tearfulness. ^[1]

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. ^[1]

Situational Depression vs Major Depression: Symptoms

Major depression and situational depression share many of the same symptoms. Patients with either disorder may experience the following symptoms:

• Changes in weight
• Changes in appetite
• Fatigue or lower energy
• Difficulty sleeping or sleeping too much
• Difficulty concentrating or thinking clearly
• Tearfulness and frequent crying
• Moving more slowly
• Restlessness
• Feelings of hopelessness or guilt
• Feelings of irritability or frustration
• Indecisiveness
• Mood swings
• Worry or anxiety
• Low mood or sadness
• Withdrawing from other people
• Loss of interest or pleasure in activities
• Physical maladies without a known medical cause
• Suicidal ideation ^[3][7]

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.

Major Depression vs Situational Depression: Causes

Neither disorder has a single known cause. Still, psychologists have different theories of what contributes to each type of depression.

Causes of Major 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. ^[2] These neurotransmitters all help regulate mood.

Trauma and negative childhood experiences also have a role in the development of MDD. ^[1] 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. ^[2]

Causes of Situational Depression

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. ^[6] An individual’s innate temperament also plays a role. ^[4] Finally, some genes have been identified as increasing one’s vulnerability to stress. ^[3]

Major Depression vs Situational Depression: Treatment

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.

Treatment of Major Depression

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. ^[2]

The most commonly used forms of therapy for MDD are interpersonal therapy and cognitive-behavioral therapy (CBT). ^[5] The focus is on changing distorted thought patterns, which can contribute to a depressed mood.

Selective serotonin reuptake inhibitors (SSRIs), such as Prozac and Zoloft, are the most commonly used antidepressants due to their effectiveness and relatively low risk of side effects. ^[2]

Other antidepressants include tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), serotonin modulators, and atypical antidepressants. ^[2]

If a patient’s MDD is severe or resistant to treatment, electroconvulsive therapy (ECT) may be effective. ^[2] This procedure involves inducing a seizure, which, for unknown reasons, helps to improve symptoms. ^[5]

Lastly, certain lifestyle changes can help to improve daily functioning. These include exercising, eating healthy meals, avoiding alcohol, and sleeping better. ^[5] Mindfulness and meditation techniques can also help the patient to manage symptoms.

Treatment of Situational Depression

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. ^[7] 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. ^[7] They can also help patients to manage future stressors.

Medication is usually not recommended unless symptoms are severe or there is suicidal ideation. ^[4]