Situational depression

What is situational depression?

Situational depression is also known as reactive depression or adjustment disorder with depressed mood. This condition is characterized by a marked change in mood and behavior following a distressing situation or event ^[1].

Situational depression shares many similarities with other mental health conditions, such as post-traumatic stress disorder (PTSD), major depressive disorder (MDD), and acute stress disorder. As such, researchers and clinicians have long debated the clarity of diagnostic criteria for this condition and how it differs from other conditions ^[2][3].

Many consider this condition to be an inability to cope with symptoms brought on by a maladaptive emotional reaction to a specific stressor ^[4]. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes adjustment disorder with depressed mood within the chapter relating to trauma- and stressor-related disorders ^[5].

Situational depression symptoms

Symptoms of situational depression share many similarities with symptoms of other conditions, such as MDD and PTSD, although they often vary in severity and duration ^[1].

Symptoms can also differ from person to person, depending on the stressor that causes the onset of symptoms. Typically, symptoms of situational depression include ^[1][2][4]:

• Extreme distress, such as regular crying, persistent low mood, and excessive worrying
• Consistent rumination about the consequences or impact of the stressor
• Fixation on the stressor and an inability to stop thinking about it
• Inability to continue with normal academic or professional functioning
• Decrease in social abilities and engagement
• Impaired self-care and hygiene
• Difficulty focusing on tasks and thoughts
• Feeling hopeless or guilty
• Changes in appetite
• Impaired sleep quality and quantity
• Inability to adapt to or cope with the changes brought on by the stressor
• Avoidance of certain situations due to fear of encountering a stressor-related occurrence
• Thoughts of self-harm or suicide

These symptoms will typically begin within the weeks or months following the specific event or stressor and tend to alleviate within 6 months after the end or resolution of the stressor ^[5].

Situational depression causes

Unlike MDD and many other mental health conditions, there tends to be a clear cause of situational depression. The condition is often brought on by the occurrence of a stressful event, severe change in circumstance, or life stressor, such as ^[1][3]:

• The death of a loved one
• Employment or financial difficulties
• Serious or terminal illness of oneself or a loved one
• Exposure to a potentially dangerous or life-threatening situation
• House burglary
• Physical assault
• Interpersonal difficulties, such as a family conflict or divorce
• World-wide issues, such as the COVID-19 pandemic
• Terrorist attacks

Situational depression diagnosis

As situational depression is not a specific diagnosis in the DSM-5, a doctor will likely use the criteria for adjustment disorder with depressed mood to establish this diagnosis. Criteria for this condition include ^[5]:

• Emotional and behavioral symptoms that emerge following a specific event or stressor
• Extreme distress and impaired functioning in social, professional, or personal areas of daily life
• Symptoms that are not caused by or are an exacerbation of another mental health condition
• Symptoms that alleviate within 6 months of the stressor being removed or resolved
• For a specifier of depressed mood, symptoms of depression are present, such as low mood and feelings of hopelessness

To determine a diagnosis, a doctor or mental health professional will gather information about the individual’s mental and physical health history, as well as any family history of mental health disorders. They will ask questions about the presenting symptoms, such as when they started, how they are impacting daily functioning, and any changes in severity or presentation ^[6].

As it is difficult to differentiate between adjustment disorders and various other conditions, doctors will require a thorough understanding of the individual’s symptoms, the occurrences that led to the onset of symptoms, and any other necessary information ^[4].

There are currently no specific diagnostic tools for adjustment disorder, although assessment questionnaires are being developed, such as the Diagnostic Interview Adjustment Disorder (DIAD). This structured interview helps to gather information about any identifiable stressors and can provide a score for the severity of presenting symptoms ^[4][7].

The doctor will also consider the presence of any other mental health conditions, as an adjustment disorder cannot be diagnosed alongside another diagnosis. They will likely ask questions relating to other symptoms, to help rule out the presence of any other conditions ^[5][6].

Situational depression treatment

Currently, evidence for the treatment of adjustment disorders is limited, likely due to the short-lived nature of these symptoms. However, treatment for this condition is often similar to that of MDD or PTSD, depending on the cause and symptoms of the individual’s condition ^[2][3].

As such, treatment differs from person to person, particularly as the stressors that cause the onset of symptoms can vary dramatically. Similarly, individual treatment will depend on the severity of the presenting symptoms and the individual’s response to treatment.

Some people may not require treatment, as the condition can alleviate on its own within a matter of months. However, if symptoms are severe or there is a risk of harm, treatment may be offered. This typically involves psychotherapy and may also include medications in severe cases ^[2].

Therapy

Psychotherapy can be helpful for those with situational depression, as it allows an opportunity to discuss emotional distress. Individuals can learn how to manage their symptoms and adapt to new situations following the stressor ^[2][3].

Cognitive behavioral therapy (CBT) may be particularly useful, as this condition involves a maladaptive stress response. CBT can focus on building skills and tools to help the individual cope with any future stressors, preventing a recurrence of depressive symptoms ^[1].

Similarly, CBT can help the individual to recognize harmful thoughts and behaviors that occur in response to stressors. They can then learn how to adapt these responses to develop more positive reactions ^[2][4].

Medication

In some cases, medication may be prescribed to reduce the severity of symptoms. This can help individuals cope in the time immediately following the specific stressor. For example, it may enable them to return to normal functioning or prevent severe harm. However, medication is commonly a short-term treatment, as symptoms will often no longer be present after 6 months ^[1].

Antidepressant medications are effective at treating depressive symptoms within the context of adjustment disorders. Several studies have found positive responses to various types of antidepressants among individuals with severe adjustment disorders. Furthermore, these studies indicate a more positive response in this group than in individuals with MDD ^[2][8].

It may also be useful to prescribe an anti-anxiety medication, such as a benzodiazepine or sedative. These medications can be effective when utilized as a short-term treatment and may reduce symptoms such as sleep disturbances and excessive worrying. However, they should not be used for extended periods, due to risks of abuse and dependency ^[2].

Self-care

People who experience situational depression may benefit from various self-care techniques. These techniques can improve overall mental and physical well-being, thus helping to reduce the severity of responses to stress. This can include ^[1][9]:

• Eating a healthy diet and engaging in regular exercise.
• Utilizing relaxation and mindfulness techniques, including yoga, meditation, and breathing exercises.
• Talking to friends and family about concerns, distress, and ongoing issues, as this can improve social engagement and provide support.
• Attending support groups with others who have had similar experiences, to share advice and support.
• Avoiding caffeine, alcohol, and drugs. These substances can greatly impact mental health and might cause or contribute to symptoms of anxiety and depression.

Situational depression vs major depressive disorder: What's the difference?

Despite certain similarities in symptoms, situational depression is considerably different from major depressive disorder, also known as clinical depression. Differences include ^{[2][6][8][10]}:

• Situational depression is directly caused by a specific situation or seriesof events. MDD is typically caused by a complex accumulation of contributing factors that tend to differ from person to person.
• Situational depression lasts for a shorterperiod of time than MDD, typically up to a maximum of 6 months. MDD can continue for extended periods and may change in severity within this time.
• People who experience situational depression are less likely to relapse than those with MDD.
• Similarly, people with situational depression are less likely to have experienced prior depressive episodes.
• Antidepressant medications are found to be more effective for episodes of situational depression than MDD.
• People who experience situational depression may go on to develop MDD. MDD cannot become situational depression, although can be exacerbated by certain stressors.