Situational Symptoms or Serious Depression: What’s the Difference?

Life can often be unpredictable and stressful. Whether it’s divorce, job loss, relocation, death of a loved one or even a flat tire, life’s stressors can trigger many emotional states, including anxiety and depression. Anxiety is a normal reaction to life’s stressors and to a point can be helpful and even controlled with some easily learned tools.

But what is the difference between symptoms that may arise in response to situational stress compared to signs of serious depression? How do you know if what you feel is normal and will pass, or needs further attention?

Clinical Depression

“Clinical depression” is a term often used to refer to one or more types of serious depressive disorders that may occur with or without the presence of a specific stressor. Generally speaking, the symptoms associated with depressive disorders are more severe in comparison to situational (reactive) symptoms, and they are more likely to be associated with problems functioning with work, school, etc. They can also have an increased risk of suicide. Common examples of depressive disorders include the following:

• Major depressive disorder;
• Persistent depressive disorder (dysthymia)—a low-grade depression lasting two or more years;
• Seasonal affective disorder (SAD)— depression onset in the winter when sunlight is reduced;
• Postpartum depression, which affects some women upon giving birth; and
• Bipolar disorder, with the current mood depressed (as opposed to manic or hypomanic). An individual who is experiencing a major depressive disorder will experience five or more of the below symptoms for at least two weeks:
• Sleep pattern changes, including early morning wakening;
• Marked diminished pleasure in all, or nearly all, activities every day;
• Observable agitation or slowed movements;
• Feelings of worthlessness, self-loathing or self-hatred;
• Excessive feelings of guilt;
• Suicidal ideation;
• Significant weight loss or gain in a month of 5% or more of body weight; and
• In children, increased irritability.

If you are worried you or a loved one might be clinically depressed, schedule an appointment with your primary care physician or a licensed mental health professional to talk about your concerns.

Situational/Stress-Related Symptoms

Situational stress can generate emotional or behavioral symptoms that look and feel very much like clinical depression. Depending on the degree of symptomatic discomfort, the treatment plan for situational or stress-related symptoms may be supportive or psychoeducational in nature and often includes the teaching of simple coping tools (find some below) that can help combat the impact of everyday stress. Remember that certain types of anxiety and sadness are often a normal response to difficult or overwhelming circumstances. Here are some symptoms shared by situational stress and clinical depression:

• Feeling sad or hopeless;
• Tearfulness, frequent crying;
• Changes in appetite;
• Trouble sleeping;
• Increased worry and anxiety;
• Headaches and stomachaches;
• Low energy or fatigue;
• Withdrawal from loved ones or social activities previously enjoyed;
• Increased absence from work or school; and
• Trouble concentrating and making decisions.

Stress Management Toolkit

Long, slow, deep breathing is your first defense — Anxiety can quickly build up into a fight-or-flight reaction, panic attack, hysterical crying or other uncomfortable feelings and symptoms. Long, slow, deep breathing can stop anxiety in its tracks because the body cannot be in danger—real or imagined—at the same time it performs this type of breathing.

Long, slow, deep breathing signals to the brain that the danger has passed. Start by doing three or more long, slow, deep breaths. Put your shoulders back and try for full lung capacity. The inhale should be 3–4 seconds, while the exhale should be 6–8 seconds. Most people do this by breathing in through the nose, pausing, then slowly blowing out through the mouth, as if they had a tiny straw between their lips. Many people feel calmer after using this technique.

Progressive muscle relaxation works — Although many people feel calmer after breathing this way, some do not. Fortunately, we have a technique to help 100% of people relax (including resistant teenagers). It’s progressive muscle relaxation (PMR). With this technique, you tighten various muscle groups, hold the tension for 3–5 seconds, then relax. I usually have people do each muscle group three times as they work their way around the body.

An online search will bring up many PMR scripts and videos. I have a video of me teaching PMR on my website called “How to Interrupt a Fight/Flight Reaction.” I always teach it to children; in fact, I encourage adults to teach it to the children in their lives:

• Pick up two lemons and squeeze them, tightening your biceps, triceps and pectoral chest muscles.
• Bring your shoulders up to your ears, pause, then drop them down.
• Pretend there’s a fly on your nose and that you can only get it off by squinting your face.
• Suck in your stomach as hard as you can, hold it, then let it go.
• Tighten up your buttocks and the backs of your thighs so that you’re sitting up higher in your seat, wait, then relax.
• Lift up your legs and tighten your quads and calves. Hold them up, then drop them down.
• Sit in a chair that comes to your mid-back. Hold your arms straight out in front of you. Now raise them up and lean backward as far as your chair can comfortably allow. Just hang there for a few seconds, looking at the wall behind you, upside down. Then come up.

Foster resilience with meditation to positively rewire your brain — Short, simple mindfulness meditation techniques can rewire the brain to experience deeper feelings of happiness and peace. Rick Hanson, Ph.D., is a neuropsychologist and author of Hardwiring Happiness and Buddha’s Brain. He teaches about the neuroplasticity of the brain and the benefits of spending a few seconds to enjoy good experiences in our imagination, which he calls “taking in the good.” Adopting these practices over time can actually change your brain’s wiring in positive ways and help you to achieve a more balanced, relaxed outlook. (I also highly recommend taking a class such as yoga, tai chi or qi-gong to help ease stress, tension and negative emotions.)

There is no magic pill, and no single technique cures situational stress or clinical depression. When life gets stressful, you can achieve a more peaceful state of mind and experience a greater sense of calm with these techniques, which experts have successfully used for decades. You can also always take the first step and contact your doctor or licensed mental health professional today.

Concerned that you or a loved one is depressed or experiencing excess anxiety or stress?

• Here are some steps you can take:
• Schedule an appointment with your primary care physician or a licensed mental health professional to talk about your concerns.
• Call NAMI’s HelpLine, 800-950-NAMI (6264), or email [email protected].
• Call the National Suicide Prevention Lifeline at 800-273-8255, or, if needed, call 911.
• Contact Crisis Text Line by texting the word “NAMI” to 741741 (standard data rates may apply).

Laura C. Strom is a Licensed Marriage and Family Therapist (LMFT 49174) with a private practice in Santa Rosa, Calif., specializing in trauma and disabilities. She is the president of the board of directors of the California Association of Marriage and Family Therapists (CAMFT.org). To learn more about Laura, visit www.LauraCStrom.com.

Note: This piece is a reprint from the Fall 2016 Advocate.