Each issue of our popular Johns Hopkins Depression and Anxiety Bulletin contains Grand Rounds, a lively question and answer section. Here's a question from a subscriber in New York.
Q. If your depression is triggered by stress, should it be treated with medication?
A. The relationship between mood disorders and stress is complicated, but we do know that they are closely interconnected. Stressful events can potentially cause changes in brain chemistry that predispose people to depression and anxiety.
It is also possible that some people's brain chemistry is already vulnerable to depression, and a stressful event -- such as the death of a loved one, moving to a new town, or losing a job -- triggers a depressive episode.
An acutely stressful event or chronic stress may spark depression by prompting feelings of helplessness and negative self-talk, especially if an individual has experienced major depression in the past.
The issue of whether medication is needed for stress-induced depression is also complex. No one should automatically be prescribed antidepressants for any problem. Your doctor should perform a physical examination and ask about your symptoms and medical history before recommending a course of treatment. In many cases, antidepressants have a crucial role in treating depression triggered by stress.
Cognitive-behavioral therapy (CBT) may also help in cases of stress-induced depression. A Canadian study showed that people who recovered from a major depressive episode through medication were more likely to fall back into negative thought patterns than people who had treated depression with CBT. The ability to recognize dysfunctional thinking and disengage from such thoughts can be a valuable tool.
