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Ask the Mental Health Expert Archives 2001-2004

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Situational Depression

Q. How would you suggest people deal with situational depression? If someone is depressed because of world events, due to going through a divorce, or due to being fired, are they treated differently than someone who is depressed without any specific cause?

A. In one sense, depression is depression is depression. That is, if a person were to develop what is termed a major depressive episode (MDE)--with full-blown symptoms of severe guilt, loss of energy, motivation, pleasure, etc., accompanied by disturbed sleep and appetite--he or she would be treated essentially the same way, whether this depression arose in the context of some specific situational stressor or came out of the blue. In fact, there is evidence showing that the course and outcome of major depression is not influenced by the presence of a known stressor or situational precipitant. If you've got the symptoms, you've got the illness--and treatment proceeds along the usual lines. That is, either psychotherapy or medication or both will be offered the patient.

In many cases of mild-to-moderate depression, psychotherapy may suffice; in more severe MDEs, medication is often necessary. Some data suggest that the best results come from a combination of medication and psychotherapy. That said, the presence of a known situational factor in a MDE may affect the specific content of the psychotherapy. For example, let's suppose someone develops an MDE in the course of a divorce. Psychotherapy may very well examine the meaning of marriage for that individual, feeling loved versus feeling abandoned, etc., and perhaps relate these issues to the individual's past response to similar traumas. But the general approach to the patient is the same whether there is, or is not, a clear precipitant to the MDE.

This is not to say that everybody who is feeling upset or down in response to a psychosocial stressor is clinically depressed, or in need of professional treatment. Many individuals reacting to such stressors will do fine simply by getting support from friends, family, clergy, or even on-line chat groups. Some will find solace in self-help manuals or non-professional support groups. But when the person presents with a full-blown MDE, especially when accompanied by suicidal feelings or ideas, he or she should seek out a health care professional. And this is true whether or not the person can identify a precipitant. If you'd like more information on depression, you may want to contact the National Depressive and Manic-Depressive Association, at 800-826-3632 (www.ndmda.org).

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December 2001

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