Johns Hopkins Health Alert
Dr. Swartz Talks About Situational Depression
Q. How would you suggest people deal with situational depression? If a person is depressed because of world events or because he or she is going through a divorce or has been fired, is the person treated differently than someone who is depressed without any specific cause?
A. I hear this question quite often and think it's extremely important to point out the similarity between depression and other medical conditions such as asthma. An asthma attack may be triggered by something in the environment (such as allergens from house dust mites and pets) but may also occur with no obvious trigger. Either way, you treat the attack the same way. Depression is no different.
Major depression is characterized by a constellation of symptoms: low mood (including sadness or apathy), changes in sleep patterns, decreased level of interest in formerly pleasurable activities, feelings of self-criticism or guilt, decreased energy, decreased concentration, changes in appetite, the sensation of feeling sluggish or mentally slowed down, and possibly thoughts of dying or actively harming oneself. These symptoms may be triggered by some outside influence or life event or may seemingly occur out of the blue, without specific cause.
- Once a person has been diagnosed as having depression, it is the severity of the symptoms that determines the course of action, not whether it is "situational" or "endogenous" (biological).
If a person has mild to moderate depression, the physician and the patient may choose together to begin with psychotherapy alone. This may take the form of cognitive-behavioral therapy, interpersonal therapy, or psychoanalysis. If the person does not improve, or worsens, the physician may suggest a trial of medication.
Of course, once a person is stable, factors that caused depression in the first place become more important. It is necessary to identify triggers and attempt to change them or modify one's response to them in the future to decrease the likelihood of relapse. It is also imperative to recognize that once a person experiences a major depressive episode, the rate of relapse is relatively high and in no way reflects a failure or commentary on the strength of the sufferer. Some people will never experience relapse of their depression.
Either way, identifying the signs and symptoms of depression and getting into treatment early can significantly decrease the length of the depressive episode. Untreated episodes last, on average, six months, while treated episodes last approximately three months. If someone has had a previous episode of major depression and knows that he or she is facing a potential trigger, it is helpful to begin speaking with a therapist or physician right away for help in responding to that trigger.
Posted in Depression and Anxiety on February 11, 2009
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"If they are both depressed than the one with long term depression has obviously not been treated." That statement is inaccurate. I was diagnosed with chronic recurrent major depression 16 years ago and since that time I have been on various anti-depressants. Although I have been consistently treated for depression (with therapy and medication) there are still events and/or times of the year that can trigger an episode. My worst episodes occur during the summer, beginning in July and worsening through the beginning of August, which is quite the opposite of many people with SAD. Even with the occasional episodes, I know from past experience that I would be suicidal without benefit of taking anti-depressants daily. Based on my pattern of episodes I work with my psychiatrist so that I can prepare for the summer doldrums, which oftentimes requires an increase in medication.
Posted by: bonniet | February 14, 2009 8:08 AM
As a long time sufferer of depression I have to say that this article makes sense as far as it goes. Depression is an acute condition that needs to be treated to restore mental and physical strength. From a position of strength the individual is better able to identify and avoid future episodes. For serious long term depression this process may need to be incremental, taken in small steps. Isn't this the standard approach to health and healing?
Posted by: Daisy Chain | February 15, 2009 9:41 AM
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I think this is true, but it is bothersome to me. To say it doesn’t matter how you got depressed just treat it is biased against those people who have long term - chronic depression. If they are both depressed than the one with long term depression has obviously not been treated. I thought some 30% of depressed people don’t respond to medication. I would imagine the vast majorities who do respond have a situational depression and most of them would have gotten better anyway. The statement that it doesn’t matter how you get depressed only that they both need treatment highlights the reality that there really is no 'good' treatment for chronic depression or dystimic disorder.
Posted by: eredmond | February 11, 2009 9:20 AM