According to the World Health Organization, depression is the second leading cause of Disability Adjusted Life Years (number of years lost due to ill-health, disability, or early death) for individuals in the age group of 15-44 years.

Contributing Factors

Situational depression occurs in response to stressful events, which could include: ✦ Loss of a loved one ✦ Financial losses ✦ Traumatic events (accidents) ✦ Being diagnosed with a serious medical condition ✦ Witnessing a natural calamity or a crime ✦ Family crisis ✦ Divorce/Breakups ✦ Life-changing events such as marriage, becoming a parent, etc. It must be noted that the stressor need not always be a negative event. It could even be a positive event that causes stress. For instance, even a wedding or purchasing a house could trigger stress.

Symptoms of Situational Depression

People of all age groups could be affected by situational depression. The characteristics might vary in case of children, adolescents, and adults. Children and adolescents are more likely to exhibit behavioral symptoms than adults. Though the loss of a loved one is bound to cause sadness and other negative emotions, in case of an adjustment disorder, the symptoms are more severe than expected. The symptoms that might be experienced by the affected individual might include: ✦ Irritability ✦ Nervousness ✦ Feelings of hopelessness ✦ Feelings of worthlessness ✦ Feelings of helplessness ✦ Crying spells ✦ Sadness ✦ Fatigue/Lack of energy ✦ Difficulty to concentrate ✦ Indecisiveness ✦ Diminished interest in activities that one enjoyed earlier ✦ Sleep-related problems ✦ Changes in appetite ✦ Withdrawal from family and friends In case of children and adolescents, the symptoms are placed under the following categories: In case of an adjustment disorder with depressed mood, the following symptoms might be experienced: ✦ Depressed mood ✦ Tearfulness ✦ Feelings of hopelessness Adjustment disorder with anxiety might cause: ✦ Nervousness ✦ Jitteriness ✦ Worry ✦ Fear of separation from major attachment figures In case of adjustment disorder or situational depression that presents with anxiety and depressed moods, a combination of symptoms from the aforementioned subtypes can be observed. In case of adjustment disorder with disturbance of conduct, the following symptoms might be experienced: ✦ Violation of the rights of other individuals ✦ Violation of the norms or rules of society In case of adjustment disorder with mixed disturbance of emotions and conduct, the symptoms can be a combination of symptoms from all the aforementioned subtypes. In adjustment disorder (unspecified), the following symptoms are included: ✦ Social withdrawal ✦ Refraining from performing activities that he/she is expected to perform Some of the behavioral symptoms of this condition include: ✦ Fighting ✦ Reckless driving ✦ Ignoring bills ✦ Avoiding family or friends ✦ Performing poorly in school or at work ✦ Skipping school or work ✦ Vandalizing property

Situational Depression Vs. Clinical Depression

As per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), the criteria for major depressive disorder includes the presence of at least five of the following nine symptoms for a period of at least two weeks: ✦ Depressed mood ✦ Markedly diminished interest or pleasure in the daily activities ✦ Change in appetite ✦ Significant change in weight (weight loss or weight gain) when not dieting ✦ Change in sleep (insomnia or hypersomnia) ✦ Psychomotor agitation or retardation ✦ Fatigue ✦ Feelings of worthlessness ✦ Diminished ability to think or concentrate ✦ Recurrent suicidal thoughts The affected individual must experience either depressed mood or diminished interest or pleasure in almost all activities. These symptoms must have an adverse effect on the patient's ability to lead a normal life. Also, these symptoms must not be linked to any other medical condition. Clinical depression could be attributed to chemical imbalances in the brain. At times, one might be genetically predisposed to depression. Depression could even be a symptom of mental health disorders. Needless to say, it could be triggered by certain events or traumatic experiences. On the other hand, a person affected by situational depression need not experience all the aforementioned symptoms. Moreover, the symptoms that he/she experiences resolve when the triggering factor or event resolves, or once the affected individual has learned to adapt to that situation. Usually, the symptoms resolve within 6 months of the termination of the stressor. However, the symptoms could persist for a longer period, if one is exposed to the stressor for a long period, or the stressor has long-lasting consequences.

Diagnosis

For the diagnosis, tests are conducted to rule out the existence of medical conditions. Besides conducting a physical examination and analyzing the medical history of the patient, a psychological evaluation is also required to ascertain if the symptoms are caused by another mental disorder such as generalized anxiety disorder, clinical depression, posttraumatic stress disorder, etc., or have appeared in response to a stressful event. In case of psychological conditions, psychologists refer to DSM-V to find out if the set of the symptoms exhibited by the patient fulfill the diagnostic criterion for any mental health disorder.

Treatment

Medical assistance must be sought, if the symptoms persist beyond two weeks, fulfilling the criterion for major depressive disorder, and these symptoms start interfering with the person's ability to perform routine activities. The probability of situational depression turning into clinical depression becomes high, if stressful events or stressors appear one after the other, not allowing the affected individual to cope or recover at all. The incidence of situational depression is higher than that of major depressive disorder, as stress has almost become a part of life. We are faced with stressful events every now and then. Though we often adapt to such events or learn to cope, if the symptoms persist, they might turn into warning signs of clinical depression in the absence of treatment. Psychotherapy Though drug therapy might help alleviate the symptoms to some extent, psychotherapy is more likely to help one recover from this condition. As the symptoms of situational depression don't often last for a long period, the duration of psychotherapy is not too long either. Talk therapy definitely works, as keeping all the emotions bottled up can aggravate the condition. Talking it out with a therapist can help. During the session, the psychotherapist attempts to identify the stressor, and determines whether the stressor can be eliminated. Besides helping the patient identify the stressor, the therapist also tries to find out ways to help the patient deal with stress. The therapist tries to help the patient interpret the stressor in a completely different way, so as to reduce the stress. He/she also tries to help the patient deal with his/her emotions, ensuring that the patient doesn't resort to maladaptive coping mechanisms, such as substance or alcohol abuse. In response to the stressful event, the affected individual might withdraw from family or friends, which in turn can worsen his/her condition. Thus, the psychotherapist also helps the patient maintain and establish relationships. Drug Therapy Drug therapy is not considered to be indispensable for the treatment of adjustment disorders. If some of the symptoms are severe, drugs might be prescribed for alleviating that particular symptom. In some cases, doctors might choose to prescribe selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), or monoamine oxidase inhibitors (MAOIs). However, these are prescribed, only if the symptoms cannot be resolved with the other treatment options.