Adjustment Disorder, with Depression

This category describes depression that occurs in response to a major life stressor or crisis. Following the diagnostic explanations for different types of depression as a way to self-diagnose is not recommended. There are many factors that go into identification and treatment of depression and other psychological problems, and only a qualified mental health professional, such as a psychologist, should diagnose psychological problems. The information provided on this web site is intended to help you determine whether you, or a friend or family member, should consult a psychologist for an evaluation and treatment. Psychologists complete a four year college degree, and then complete an average of five to seven years of graduate professional training, resulting in either a Ph.D., Psy.D. or Ed.D. degree in psychology, plus additional experiential training, prior to becoming licensed to practice. The information presented here is general, and simplified. When you need to talk to someone who can help with depression, consult a psychologist.

Depression, Not otherwise specified
Some professionals portray this category as a “garbage pail” diagnostic category for depression. If someone is obviously depressed, but does not fit into any of the other categories, then this diagnosis is made. However, it is not a garbage pail, but provides a valuable way to categorize depression that does not fit into the other categories. The alternative would be to have several additional diagnostic categories. That is not useful, unless the different diagnoses require different treatment. This category includes people with serious depression, but not quite severe enough for a diagnosis of a major depression, so moderate depression would be included here. This would include people with mild to moderate depression, who have not been depressed long enough to be diagnosed with Dysthymic disorder, which requires depressive symptoms for two years. It also includes those individuals who continue to be depressed, in response to some traumatic event, but the depression has lasted longer than expected for an adjustment disorder with depression. In an adjustment disorder, the expectation is that the depression will last no more than about six months after the stressor has ended.

The treatment plan remains the same as for other depressive disorders. Cognitive psychotherapy is effective in reducing depressive symptoms, and the cognitive distortions that appear to cause the mood problem. Interpersonal psychotherapy is used to help the individual resolve relationship problems that are causing the depression. If the symptoms are severe, the individual may be referred for a medical evaluation to assess the need for medication, but in most cases medication is not necessary.

The different diagnostic categories of depression are sometimes more useful for research purposes than for treatment purposes. When making distinctions between different categories within a particular class of disorders, such as depression, psychologists are looking for differences that may indicate different causes, or that require different treatment.

Also, in completing research on treatment for a specific category of depression, the differences become important in measuring the results of treatment. For example, if a study is comparing different treatments, it is important that the treatment groups are similar. We would not want one treatment group to include mostly people with a major depression and another group to include mostly people with an adjustment disorder. If that happened, the research results would be tainted. Generally, moderate depression requires less treatment, and responds better to treatment, than severe depression. If we are comparing different types of treatment, the different treatments must be applied to similar problems.

To some extent then, the use of a diagnosis helps the psychologist predict the expected duration of treatment, or to anticipate possible issues that might arise in treatment. The history of symptoms, especially the duration of the depression, can help a psychologist understand the overall impact of the depression on a person’s life. Someone who has been depressed for many years, either with Dysthymic disorder or recurrent major depression, will have a multitude of issues related to how the disorder has taken over his/her life. This is very different than the clinical picture presented when a person becomes depressed initially after a specific trauma, and recovers.

Adjustment Disorder, with depressed mood
This is also called a “reactive depression.” The diagnosis of an adjustment disorder implies that specific psychological symptoms have developed in response to a specific and identifiable psychosocial stressor. However, this diagnostic group (adjustment disorders) is a “last resort” category. If the symptom picture suggests that the person meets the diagnostic criteria for another psychological disorder, than this diagnosis is not used. For example, if a person experiences a trauma, and develops the symptoms of a major depression, then the diagnosis of adjustment disorder is not used, even though the depression developed in response to a psychosocial stressor. So, adjustment disorder with depression is used to categorize mild to moderate depression, following a stressful event.

Also, the depressive symptoms related to an adjustment disorder should be treated and dissipate within six months following the end of the stress that produced the reaction. If the symptoms last longer, then the above diagnosis of Depression, not otherwise specified, is probably more appropriate. There is an exception to this rule, as some stressors continue over a long period of time, rather than occurring as a single event. For example, if a person is harassed on the job, that can continue for months. In such a case, the depression may not be severe enough for a diagnosis of major depression, but it would continue for more than six months. But, since the stress is continuing, then the adjustment disorder diagnosis could still be used.

The symptom picture is similar to other depressive disorders, and the recommended treatment is still cognitive-behavioral therapy and/or interpersonal therapy. However, because of the relationship between the symptoms and a specific stressor, there is more emphasis put on resolving the problem that created the stress. This may involve making concrete changes in the way the person manages his/her life, and may require specific action and decision making. (e.g. If job stress is resulting in depression, the person may need to decide whether changing jobs is the most appropriate solution.) Often people become depressed in reaction to psychosocial stressors when they don’t believe a solution exists to their problem. In such cases, helping the person develop a reasonable solution is a key part of the treatment process.