Adjustment Disorder With Depressed Mood And Mental Health Support

Please note: In previous versions of the ICD manual, including ICD-10, “adjustment disorder with depressed mood” may have been diagnosed. In the most recent adaptation of the ICD, the ICD-11, adjustment disorder is separated from depressive disorders. Situational depression may be diagnosed instead. 

It can be natural to experience uncomfortable emotions after a stressful event or major life change. However, in some cases, anxiety, sadness, or stress following such an incident can start to impact everyday life adversely. When you are experiencing depressive symptoms after a major life change, such as divorce, a breakup, or moving to a new city, it may be a sign of adjustment disorder with depressed mood. This condition is recognized under code F43.21 in the ICD-11 (International Classification of Diseases, 11th Revision). Understanding adjustment disorder with depressed mood, the symptoms it presents, and how it is treated can help you get timely support. 

What is adjustment disorder with depressed mood?

Adjustment disorders belong to a group of conditions that can develop after a significant life change. Experiencing a divorce, going through a break-up, or moving cities are some events that may trigger short-term, stress-related mental health symptoms.

• Symptoms began within one month of the stressful event
• The stressor can be clearly identified 
• Symptoms cannot be attributed to another disorder
• Symptoms are not due to grief over the passing of a loved one
• Symptoms have occurred for less than six months
• Symptoms significantly affect everyday activities and social interactions

Common symptoms of adjustment disorder

People with adjustment disorder may present with various symptoms, including fear, nervousness, risk-taking behaviors (especially in adolescents), excessive worry, marked distress, irritability, difficulty adapting to a specific event, preoccupation, and sadness. Depending on the individual and the circumstance, these symptoms may vary in intensity. A doctor or mental health professional can determine whether you have an adjustment disorder and guide you through treatment options.

How do they show up day to day?

The thoughts, emotions, and symptoms associated with adjustment disorder may be reflected in everyday behaviors, making daily functioning more challenging. You may begin:

• Withdrawing from social interactions and avoiding friends and family members, even when an emotional connection may be valuable.
• Losing interest in activities you once enjoyed since they feel less engaging and meaningful. 
• Having difficulty concentrating in various settings, from watching television to fulfilling work assignments.
• Neglecting responsibilities, such as school assignments, caregiving duties, or paying the bills.
• Misusing substances and using alcohol or drugs to cope with the feelings associated with a major life change.

When to seek urgent support

When mental health problems and symptoms cause significant impairment in daily life, such as preventing you from providing quality child care, negatively impacting relationships, or leading to feelings of self-harm, it can be important to seek immediate help. In these situations, you may call or text the Suicide and Crisis Lifeline on 988. 

How adjustment disorder differs from major depression

Because symptoms of adjustment disorder may resemble symptoms of a depressive disorder like major depressive disorder (MDD), it can be crucial to know the difference between them. There are some key differences in symptom severity, duration, and connection to a specific stressor.

Time course and duration

Adjustment disorder is a short-term mental health condition that occurs in reaction to a major life change. People typically recover from adjustment disorder symptoms within a 6-month period. For example, people may move on from a break-up after a few months. 

Major depressive disorder (MDD) is a long-term, chronic mental health condition that can occur for multiple years and is not necessarily tied to a specific event. As well as experiencing symptoms for a longer period, people with MDD may experience more severe symptoms.

Why a clear trigger matters

The presence of a clear trigger, whether an illness or a break-up, is important for identifying and treating adjustment disorder because it ties mental health symptoms to a specific event. In clinical settings, it is helpful to understand where the emotional or behavioral reaction stems from. 

Diagnostic criteria clinicians use

Oftentimes, clinicians will use the Diagnostic Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) when formally diagnosing clients for adjustment disorder. The diagnostic criteria in the DSM-5 differ slightly from those in the ICD-11. 

The DSM criteria in plain language

According to the DSM-5, for individuals to be diagnosed with adjustment disorder, symptoms must appear within 3 months of an identifiable stressor, stress reactions should be worse than normal, there should be disruptions in daily functioning, symptoms should not become worse over time, symptoms likely dissipate within 6 months of the stressor, and the stressor should not be the passing of a loved one.

ICD codes and adjustment disorder stereotypes

In the ICD-10, adjustment disorders were listed under the category “Reaction to severe stress, and adjustment disorders”—a section that was given the code F43. The ICD-10 code for adjustment disorders, F43.2, was reflected in the codes for each of the seven conditions in that section. Adjustment disorders (F43.20-F43.26) in the ICD-10 included:

• Adjustment disorder, unspecified (F43.20)
• Adjustment disorder with depressed mood (F43.21)
• Adjustment disorder with anxiety (F43.22)
• Adjustment disorder with mixed anxiety and depressed mood (F43.23)
• Adjustment disorder with disturbance of conduct (F43.24)
• Adjustment disorder with mixed disturbance of emotions and conduct (F43.25)
• Adjustment disorder with other symptoms (F43.29)

Specific forms of depression, anxiety, and other negative symptoms may fall under certain codes in the ICD-10. For example, separation anxiety is found within adjustment disorder with anxiety (F43.22)

The difference between the ICD-10 and the ICD-11

In the ICD-10, each section or code reflects a different type of adjustment disorder, to help both clients and clinicians understand the presented mental health condition at a glance. This can potentially help with focused treatment approaches. 

However, the ICD-11 has undergone a major simplification, and each subtype has been subsumed into one form of adjustment disorder, under the code 6B43. This approach allows clinicians to focus on the core nature of the condition during treatment, rather than each and every symptom.

What qualifies as a stressful event?

The ICD notes that the symptoms of an adjustment disorder must not have developed without the presence of a stressor. Multiple events, life changes, and experiences may fit this criterion. The ICD lists several categories of potentially stressful events, including stressors that impact an individual’s support system, lead to a significant transition in life, or could be perceived as a crisis. Some specific examples may include the following:

• Divorce
• Relationship concerns
• Illness in yourself or a loved one
• Moving to a different location
• Retirement
• Starting college
• Experiencing sudden financial duress
• Sudden job loss or job changes 

Treatment options and what recovery can look like 

Because adjustment disorder is a temporary and situational disorder, medication may not be prescribed unless it offers short-term relief. Instead, combining therapy and lifestyle changes may help you manage symptoms and work through emotions arising from the stressful event you experienced. 

Therapy approaches commonly used

One of the first-line treatments for adjustment disorder may be therapy. A therapist can help you identify how your thoughts relating to a stressful event may affect your emotions and behaviors. During sessions, you may learn coping skills and stress-management techniques to cope with future challenging emotions.

Structured, outpatient mental health visits can be held both in-person and online, allowing you to engage in evidence-based forms of therapy from any location. Cognitive behavioral therapy (CBT) is a common therapy approach used to challenge negative thoughts, address guilt, develop acceptance, and encourage adaptation. Symptoms of adjustment disorder can appear when you find it difficult to adapt to your present circumstances and are preoccupied with the event. However, CBT can disrupt patterns of thinking and behavior so you can live life to the fullest again.

Self-care support between sessions

Through intentional lifestyle changes, you may be able to reduce the symptom severity of adjustment disorder, anxiety, and depression. Physical activity has proven benefits when it comes to depression. Exercise helps produce endorphins, which can boost your mood and enhance brain function. Consider going for daily walks, taking up swimming, jogging, or biking, or developing an at-home exercise routine.

Stress-management strategies may also be beneficial, helping you to cope with common adjustment disorder symptoms and embrace the present moment.  Practical stress management techniques may include journaling, meditating, deep breathing, and muscle relaxation exercises. Before going to sleep, you may also foster relaxation in your life. For example, stay away from screens an hour before bed, make a decaf tea, or read a book before bed to get yourself ready to sleep.

There is evidence of a connection between diet and depression. Eating healthy foods can improve your mood, provide you with energy, and help you better address symptoms of an adjustment disorder. Consider incorporating elements of a Mediterranean diet, which is high in fruits, vegetables, nuts, whole grains, and beans.

Getting support through BetterHelp

In some cases, individuals may not reach out to a therapist during a stressful period due to financial barriers or burnout. In these cases, it may be helpful to try online depression therapy through a platform like BetterHelp. Online sessions can be arranged on a flexible basis, according to your personal schedule and mental health goals. In addition, online therapy can also be more cost-effective than in-person options.

What does starting therapy look like online?

After filling out a questionnaire, you are matched with a therapist according to your specific needs, such as a cognitive behavioral therapist for adjustment disorder. During an initial session, you may build rapport with a therapist, discuss mental health goals, and reflect on symptoms. From there, a detailed treatment plan can be created. Your therapist can provide you with valuable resources, like at-home exercises, self-help apps, guided meditations, mood trackers, and journaling prompts. 

Studies suggest that online therapy can address symptoms of mental health conditions related to stress, such as adjustment disorder and depression. In one study of app-based online cognitive-behavioral therapy for depression, which included over 300 participants, researchers found that symptoms of depression were significantly improved, with results similar to those of in-person studies.