Reactive Depression: What It Is, Symptoms And Common Causes
We speak of reactive depression when we want to refer to a mood disorder that occurs in response to one or more external events. This is classic depression, the most common. The one we think of when we imagine a depressed person. What we probably do not imagine nor can we understand with the same intensity is the depths of these people’s pain.
We will present a little information about its causes, what the most frequent clinical manifestations are and how we can improve the lives of people with reactive depression.
The distinction between endogenous and reactive depression was made by Paul Julius Moebius in the 19th century. This differentiation assumes that there is a distinction between depressions that occur due to biological causes and those that occur due to psychosocial causes. The truth is that although the empirical support for this supposed distinction is far from conclusive, it can be useful to communicate quickly between health professionals and quickly know what they are facing.
In reactive depression, a disorder that women have between a 10 and 25% risk of developing throughout their lives and for men it ranges between 5 and 12%, the disorder occurs after the presence of a stressor. that causes the development of depression. Let’s imagine a breakup, the death of a loved one, the loss of a job or any type of life change that is perceived as very stressful and uncontrollable.
What is important in depression, beyond the objective severity of the event, is how it is perceived as a threat. Each individual has different coping skills, and for this reason each person experiences problems with more or less difficulty. What for one may be a traumatic event from which they can recover after 2 weeks, for another may be a blow that leaves them emotionally destroyed. For this reason, in the evaluation of the patient we must keep in mind what coping skills the patient had before the event.
Reactive depression is always a complex and heterogeneous clinical picture; no two cases are the same. An added problem is that most of the symptoms are not exclusive to depression, and it is also difficult to differentiate what is an adjustment disorder after a very stressful situation from what has become a well-established reactive depression. As a guide, it is possible to group depressive symptoms under five different categories.
Mood symptoms
Sadness is present in 9 out of 10 patients with reactive depression and is usually the main complaint of those who find the courage to come for a consultation. In most patients, this sadness manifests itself in the form of hopelessness and permanent helplessness. It is the feeling that the future holds nothing good, that everything positive has ended and nothing remains but misfortune and misery. In the most serious cases, sadness can be overshadowed by a feeling of emptiness so great that they deny feeling anything. As if they were internally dead.
In children, on the other hand, rather than being depressed, they show irritability or instability. Many of the children whose parents separate in an undesirable way express depression through explosions, bad answers or tantrums over issues that were never a source of problem before.
Motivational symptoms
Reactive depression causes the patient to lose interest in activities that they previously liked. He doesn’t feel like doing them anymore, nor are they satisfactory when he does them. They lose their favorite hobbies, their daily routine, and they have stopped enjoying themselves in general. Even energy is reduced, to the point where the person has so little strength that getting up and showering can be a huge victory.
The movements are very slow and expensive, requiring a lot of energy. This psychomotor retardation is sometimes so severe that patients fall into the so-called depressive stupor, a state similar to catatonia that resembles almost total motor paralysis. The heterogeneity in symptoms allows us to also find patients who, instead of being slowed down, are very agitated and cannot stop biting their nails or smoking restlessly.
Cognitive symptoms
Just as it happens with movements, thinking is slowed down. It is so difficult for them to think that those who have a minimally demanding job are incapable of performing normally. In children, for example, academic performance suddenly drops, reflecting a lack of concentration due to depression. Not only concentration, but memory is also altered. In depressed elderly patients, these memory problems can be confused with dementia, but the non-progression of memory impairment is what indicates whether it is depression or not.
The depressed person evaluates everything negatively. He thinks he is worthless, that the world is a terrible place and that the future is bleak. They have a biased thinking style that prevents them from seeing anything other than through pessimistic glasses, perpetuating depression. Sometimes depression presents with hallucinations consistent with the mood, for example blaming or accusatory voices.
Somatic symptoms
Although vegetative symptoms are more characteristic of endogenous depressions, We also find problems with sleep such as hypersomnia or insomnia in reactive depression. In fact, in many patients, sleep disturbance is the first symptom to appear and the last to disappear. Body pains such as headaches, digestion problems, muscle or lower back pain occur.
When you stop doing activities, you also stop seeing your friends, it is common for the social sphere of the patient who falls into reactive depression to gradually deteriorate. These people reject social contacts because they are no longer pleasant and have no energy, and others end up stopping trying. Total social isolation can occur, since social contact ends up generating anxiety, overexertion and feelings of failure.
Treatment of reactive depression
The treatment first involves establishing a bond with the patient and ensuring that this person counts on us for their improvement. Once she feels truly understood, she may agree to begin recovering lost activities and becoming behaviorally active, recovering her previously lost social life. In parallel but always little by little, we must try to identify the negative thoughts that cloud the thinking of the depressed patient and apply cognitive restructuring. Pharmacological therapy using antidepressants such as SSRIs, SNRIs or tricyclics, for example, is also indicated.
Due to the reactive nature, The emotional processing of the stressful situation that caused depression will also be addressed. Poorly managed grief or a life experience that is not emotionally processed can be the subject of intervention. The psychologist will help the patient acquire coping and emotional management skills to be able to turn the page. The memories will still be painful and sad, but they should not interfere with the person’s normal functioning.
