Adjustment reaction versus depression
An adjustment reaction is an emotional response to a distressing event, with fluctuating feelings and sleep, appetite and energy preserved.
Remember
Fluctuating emotions after a distressing event, with sleep, appetite and energy preserved, point to an adjustment reaction, whereas low mood and lack of enjoyment lasting at least two weeks point to depression.
Memory aid
An adjustment reaction is the mind reacting to an event and bouncing around, whereas depression is the whole system slowing down
Picture the mind bouncing around after an event for an adjustment reaction, and the whole system slowing down for depression.
An adjustment reaction is an emotional response to a distressing event, such as the end of a relationship or failing an important exam. The symptoms fluctuate and include anger and frustration. Sleep, appetite and energy levels are not particularly disturbed.
Clinical depression looks different. Its features include low mood, a lack of energy and a lack of enjoyment (anhedonia, the loss of the ability to enjoy things), and it comes on more gradually. Lack of sleep (insomnia), poor appetite and low libido (sex drive) are common. These are the biological symptoms (those that involve the body's basic functions), and their absence is a key clue.
Depression needs low mood or loss of interest with other depressive symptoms present on most days for at least two weeks. Two weeks having passed does not by itself make depression, as the diagnosis depends on the symptoms present during that time.
A distressing event can set off an adjustment reaction and also trigger depression. If an adjustment reaction persists and depressive symptoms appear, it may have turned into depression. In practice, ask three things: is there a clear trigger, do the emotions fluctuate, and are sleep, appetite and energy intact? If so, an adjustment reaction is likely.
Key facts
- Adjustment reaction
- fluctuating feelings such as anger and frustration after a distressing event, with no particular disturbance of sleep, appetite or energy
- Clinical depression
- low mood or loss of interest with other depressive symptoms, coming on more gradually and lasting for at least two weeks
- Biological symptoms
- insomnia, poor appetite and low libido are common in depression
- Timing
- adjustment symptoms typically begin soon after the stressful event and resolve within six months once it has ended
- Duration alone
- two weeks passing does not by itself make depression, because the diagnosis depends on the symptoms present during that time
- Review if
- an adjustment reaction persists and depressive symptoms appear, as it may have turned into depression
Exam traps
- Distress that begins straight after a stressful event does not point to depression, because an adjustment reaction is tied to an event, whereas depression usually comes on more gradually.
- Two weeks passing does not by itself make a diagnosis of depression, because the diagnosis depends on the symptoms present during that time.
- Preserved sleep, appetite and energy argue against depression, because insomnia, poor appetite and low energy are common in it.
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