A few years ago, it was quite common to describe yourself as feeling blue, a bit down, or unhappy for a time. The rise in depression has raised some new questions. Are more people depressed, or has there just been a rise in diagnosis? Is it possible that a lot of people just feel down from time to time?
According to the National Institute of Health (NIH), “Everyone feels sad or low sometimes, but these feelings usually pass. Depression (also called major depression, major depressive disorder (MDD), or clinical depression) is different. It can cause severe symptoms that affect how a person feels, thinks, and handles daily activities, such as sleeping, eating, or working.”
Situational depression is different. It has a cause, lasts a certain amount of time, and then it goes away. I’m not saying it’s easier than MDD, but it is different and, therefore, requires a different approach from diagnosis through to treatment.
Key differences
Most of us have felt situational depression. It might have been a time in college when you had no money to your name and no idea if you were on the right path; it could be triggered by a divorce, break up, or the loss of a job. It is even one of the stages of grief when you lose a loved one. What all these situations have in common is that they are entirely environmental, and they pass. They are not the fault of a ‘chemical imbalance.’
With the rates of depression reaching record highs, education is rising as to how exactly we can distinguish between the many mood disorders; courses like online nurse practitioner programs put a heavier emphasis on listening to what the patient has to say in order to understand the key difference that so many overlook.
Time
The Diagnostic and Statistical Manual 5th edition (DSM-5) is the gold standard when it comes to diagnostic criteria. The trouble is the DSM-5 only requires the criteria for MDD to be met in the last two-week period, so depressed mood and/or loss of interest/pleasure must be present in that period. If you are experiencing situational depression, you could meet the criteria and get a diagnosis for MDD when, in reality, your mood could well improve, given more time.
Triggers
Pinpointing the cause of depression is often difficult. Some people have no idea what is causing their mood, and some simply put it down to a ‘chemical imbalance.’ With situational depression, it should be a bit easier to tell: a traumatic event or a big life change. It’s generally a reaction to something that is difficult to come to terms with; it’s an adjustment period, not a chronic mood disorder.
Treatment
The best treatment for situational depression is usually just time and support. Talking about the issue can expedite recovery. Support groups or therapy, particularly short-term cognitive behavioral therapy (CBT), can also provide valuable assistance during this period. On the other hand, clinical depression usually requires more long-term treatment, often combining psychotherapy, like CBT, with certain medications. When someone is dealing with situational depression, offering patience, empathy, and consistent support can significantly improve their symptoms. Alongside professional help, engaging in activities that bring joy and practicing self-care can contribute to their well-being. It’s essential to recognize that each individual’s experience with depression is unique, and tailoring the approach to their needs is crucial for effective treatment and recover
The problem with prescription
One of the big issues has to do with the prescription process for antidepressants. In the US and many other countries, your local GP can diagnose and prescribe just about every kind of antidepressant on the market. The problem with this? Well, a recent study found that while 78.4% of GPs thought diagnosing depression was their responsibility, only 29.6% of them thought they should treat it–yet they are treating it. In 2020, 20.3% of adults in the US received treatment for a mental disorder, 16.5% had taken prescription medicine, and only 10.1% had seen a counselor or therapist. This highlights that, for many, the path to treating their depression ends with a repeat prescription for Zoloft.
According to the Centers for Disease Control (CDC), More than 60% of Americans taking antidepressant medication have taken it for two years or longer, with 14% having taken the medication for 10 years or more. So, do all these people have MDD? Or are we doing long-term treatment for short-term situational depression?
The difference matters
Getting the right diagnosis matters for patients as much as getting the diagnosis right should matter to doctors. The treatments are pretty different, and they have a real effect on how well the patient recovers.
Situational depression is triggered by external events and is transient, meaning that part of the solution is to wait it out; clinical depression is a bit more complex and can endure.
A concerning trend is an overreliance on antidepressant medication, with many individuals receiving prolonged treatment without clear indications of persistent clinical depression, especially when there is mounting evidence that lifestyle changes like exercise can be as good, if not better, at treating depression, especially when it is less severe.
The consequences of misdiagnosis go way beyond the individual patients and healthcare practices. With a significant portion of individuals and the population as a whole receiving long-term antidepressant treatment, questions arise about the appropriateness of such interventions for situational depression. Are we inadvertently medicalizing normal emotional responses to life challenges? Are patients receiving the most effective and appropriate care for their specific condition?
Ultimately, getting the diagnosis right is critical so we can treat the individual, not the society. To do so, we need to know the difference between these two conditions. At the end of the day, it comes back to client-centered therapy.
**Please note this article should not serve as medical advice; if you or someone you care about is struggling, contact one of the many helplines, your GP, counselor, or psychologist.