Situational depression: symptoms, how long it lasts and what helps

What is situational depression?

The WHO’s diagnostic manual describes adjustment disorder as “a maladaptive reaction to an identifiable psychosocial stressor”: you are preoccupied with what happened, with “excessive worry, recurrent and distressing thoughts about the stressor, or constant rumination about its implications”, and you struggle to adapt, so work, family or social life suffer. As the manual puts it, “if functioning is maintained, it is only through significant additional effort”^[2].

The US manual (DSM-5) divides adjustment disorder into types, and the one where low mood is the main problem is called “adjustment disorder with depressed mood”. The others are with anxiety, with mixed anxiety and low mood, with disturbed behaviour, mixed, or unspecified. The WHO’s ICD-11 dropped these types, because research has not shown that they really differ^[3].

Situational depression symptoms

The defining sign is that the event takes over your thoughts and you cannot seem to adjust^[2]. You may also notice:

• Feeling sad, hopeless or tearful, and pulling away from other people^[1]
• Feeling nervous, tense or worried^[1][2]
• Avoiding reminders of what happened, or not wanting to talk about it^[2]
• Drinking, smoking or using other substances more^[2]
• Physical complaints, such as a racing or skipped heartbeat, trembling or twitching^[1]
• Problems coping with work or social life: symptoms are “often severe enough to affect work or social life”^[1]

Sometimes symptoms are severe and include thoughts of suicide^[1]. If that is happening to you, go straight to when to get help.

What can trigger it?

Almost any stressful change. The WHO gives examples such as divorce or the end of a relationship, losing a job, being diagnosed with an illness, a new disability, and conflict at home or work. The stressor “can be of any severity or any type”: it does not have to be traumatic^[2]. MedlinePlus adds money worries, illness in someone close to you, general life changes and “moving to a different home or a different city”^[1].

“There is no way to predict which people who are affected by the same stress are likely to develop adjustment disorder”, though how you have learned to cope with stress before may play a part^[1]. The WHO notes that it can be made worse when family or community support is limited^[2].

Adjustment disorder is among the conditions doctors diagnose most often, but nobody knows exactly how common it is in everyday life, because studies measure it in different ways^[11]. It is common after a serious diagnosis: about 15 to 19% of people in cancer and palliative care have it^[12].

Situational depression vs clinical depression

Many people assume that if there is a clear trigger, it must be “only” situational. That is not how doctors tell them apart. Some low mood is a normal reaction to events like divorce or job loss, and depression is told apart from it “by the severity, range and duration of symptoms”. The WHO is explicit: if the signs of a depressive episode are there, it is depression “even if there are identifiable life events that appear to have triggered the episode”^[2]. The NHS also notes that life events such as bereavement or losing your job can bring on depression^[9].

Depression (also called major or clinical depression) means symptoms “most of the day, nearly every day, for at least 2 weeks”, and one of them must be low mood or a loss of interest or pleasure in most activities^[6]. Adjustment disorder can include some depressive symptoms, but not enough of them, or not severe enough, to count as depression^[2].

Based on the WHO’s ICD-11, the US manual, NIMH and the NHS^{[2][3][6][8][9][10]}.

There is no blood test or quiz that can tell you which one you have. A doctor or therapist will ask about what happened, your symptoms and how long they have lasted. The free depression self-test can help you decide whether to talk to someone.

Is it grief, stress or situational depression?

Feeling shaken after something hard is normal. Reactions that “resolve within a few days do not typically warrant a diagnosis of adjustment disorder”^[2]. A low mood “often gets better after a few days or weeks”^[10].

Grief after a death is treated differently. Normal grieving is not adjustment disorder^[1][3]. “Grief is an entirely natural response to a loss, while depression is an illness”^[8]. In grief, painful feelings tend to come in waves, mixed with good memories, and self-esteem usually holds up; but grief and depression can exist together^[7]. Grief that stays intense for much longer than 6 months, or longer than is usual in your culture, may be prolonged grief disorder, which a professional can assess^[2]. See our page on grief counselling.

How long does situational depression last?

It usually starts soon after the change: within a month, according to the WHO, although it can come later, for example 3 months after^[2]. The US manual allows up to 3 months^[3].

The 6-month rule is often misquoted. It is counted from when the stressor and its consequences have ended, not from when your symptoms started: “once the stressor and its consequences have ended, the symptoms resolve within 6 months”^[2]. So if the situation is still going on, such as an ongoing divorce, a long job search or a move that keeps being hard, it can last longer^[1]. The WHO notes that sudden events tend to cause a quicker, shorter reaction, while ongoing ones tend to cause a later and longer one^[2].

It does not always pass on its own. A review of 31 studies found that adjustment disorder tends to be milder than other conditions, and people often improve, but many still had it, or had developed another condition, months to years later^[4]. In one large study of injured patients, those with adjustment disorder at 3 months were more likely to have another mental health condition a year later^[5]. If symptoms last more than 6 months after the stressor has ended, doctors usually look at another diagnosis^[2].

How to cope: what you can do yourself

The WHO notes that symptoms usually ease “when the stressor is removed, when sufficient support is provided, or when the affected person develops additional coping mechanisms or strategies”^[2]. Advice from the NHS and NIMH for low mood points in the same direction^[6][10]:

• Talk about it with a friend, family member, health professional or counsellor, or try peer support^[10].
• Keep a routine: regular bedtimes and wake-up times, regular meals, and some movement. NIMH notes that “just 30 minutes a day of walking can boost your mood”^[6].
• Set small targets rather than trying to do everything at once^[10].
• Work on what you can change. “If you know what’s causing your low mood it might be easier to find ways to manage it”, and try not to dwell on what you cannot change^[10].
• Delay big life decisions until you feel better, if you can^[6].
• Go easy on alcohol, cigarettes and drugs as a way to cope^[6][10].

Structured self-help can help too. In a small trial, a self-help workbook based on CBT, with no therapist contact, reduced the preoccupation that drives adjustment disorder^[17]. If you are not feeling better after a few weeks, or things are getting worse, get support rather than waiting it out.

Treatment: therapy, and where medication fits

Talking therapy

“Most mental health professionals recommend some type of talk therapy”, to help you change how you respond to the stress in your life^[1]. CBT has the most support: the most recent review of trials found that CBT, both in person and online, “may be effective”^[14]. Online and app-based programmes also look promising, in a small number of studies^[16]. In a review of studies on getting back to work, problem-solving therapy helped people return to work part-time^[18].

To be honest about the evidence: research on adjustment disorder is limited, and a review rated the quality of evidence for all treatments as “low to very low”^[15]. Talking therapy is still the main recommended approach^[1].

Medication

MedlinePlus says medicines may be used “only along with talk therapy”, for example if you are anxious most of the time, sleeping badly or very low^[1], and the evidence for medicines in adjustment disorder is weak^[15]. If it turns out to be depression, depression guidance applies: for milder depression, therapy is usually tried first^[6][19]. Medication is a decision to make with a doctor.

On Bliss Therapy

On Bliss Therapy you choose a therapist who speaks your language, by video, with no waitlist. 46 psychologists and counsellors list depression, with sessions from €30 (about £25); 36 of them list CBT. In the UK you can also see a GP, or refer yourself to NHS talking therapies^[10]. In the US, start with your doctor or another health care provider^[6].

Our therapists are based outside the UK and the US, so they are unlikely to be on UK registers or covered by US health insurance. Ask any therapist about their training and their registration in the country where they practise.

When the change is a move abroad

Moving is a recognised trigger^[1], and moving countries can stack several stressors at once. In a survey of 1,310 people who moved from Hong Kong to the UK, about 3 in 10 screened positive for likely adjustment disorder, and common stressors included moving home, a language barrier, cultural differences, money problems and a career break^[13]. That was one survey of a particular, often difficult move, so it does not mean most people who move abroad will struggle. But being far from family and friends matters: the WHO notes that limited support can make adjustment disorder worse^[2].

Language can matter in therapy too. In an older review of studies, therapy in clients’ own language (when it was not English) was twice as effective as therapy in English^[21], and therapy adapted to people’s culture works better on average^[22]. See our page on therapy for expats.

When to get help

See a doctor or a therapist if you have had a low mood for more than 2 weeks, you are struggling to cope, or the things you are trying yourself are not helping^[10]. Get help, too, if it is affecting work or relationships, or has not eased months after things settled^[2].

Situational depression is sometimes seen as mild, but it can be serious. Studies, mostly in hospitals, have found a strong link between adjustment disorder and suicidal thoughts and behaviour^[20]. If you are having thoughts of ending your life or harming yourself, get help now.