Can anyone tell me why my (old) Dr would not give me anti-depressants for 'situational depression'

[Camelsshouldnteatcrisps]

My old Doctor would not give me anti depressants because she felt that my depression was caused by the situation that I was in. My situation got worse and I became more miserable and finally changed doctors.

Thankfully the new doctor was happy to prescribe and I am starting to feel better...but not before a lot of damage has been done.

Has anyone heard of this before or know anything about 'situational depression'....thank you.

It used to be called 'reactive depression', which was thought to the in contrast to endogenous depression (not related to life events).

It used to be thought that antidepressants were to be used for the endogenous type, not reactive.

Glad you finally got your pills, op! I have experienced situational/reactive depression before. I was feeling that way for more than 6 months so thankfully the gp recognised there was a problem even though the depression had originally started cos of the situation. Once the pills started to work, the clouds started to lift and even though the situation hadn't changed, my mindset had changed completely, I was able to deal with stuff in a much more rational way and felt so much better. I came off the pills gradually a year later and have remained fine ever since, even though the situation lasted a couple of years longer.

Good luck.

thank you...so does that mean that my old doctor was out of date or had just refused to change their thinking?

I first asked for the anti-depressants 2 years ago.

Thank you curlyhairedassassin...I ended up in a spiral in the end, the depression was making my situation worse and so on.

I think there is/was a feeling that anti depressants for 'situational' (ie reactive) depression isn't right way forward if the situation is unlikely to change. Instead learning to deal with/cope with the situation or affecting change in it is seen as the best way to go. But as you recognise yourself once in a spiral the reactive depression can take on a new life. Glad you're starting to feel better.

Leonie

Can you link to the evidence for that please?

I agree with leonie, if someone's depression is caused by a "chemical imbalance" (yes, i know its not that simple) then they will benefit from having that imbalance put right. However, constant stress can cause that chemical imbalance IMO so i think if someone is under long term pressure then actually their depression is likely to become and illness that will respond to treatment and equally may remain if untreated after the source of the stress has been removed. I think the fact that the OP felt bad for such a long period of time then it would have made her ill.

That link says that antidepressants are not usually recommended as first line treatment for mild depression, that is not remotely controversial.
It doesnt divide it into reactive/situational or endogenous.

Clinical depression is far more than being unhappy with life or being miserable.

If you are in an awful life situation then it is natural to feel down. For example if you are going through divorce or a brevement then in some cases messing about with your brain chemistry can make it harder to think. A lot of anti depressants have horrid side affects, particularly with reactive depression.

Someone going through a rough patch in their lives may well have healthy brain chemistry. Giving anti depressants will not make the person better until life changes.

The problem is that someone with reactive depression needs talking theraphies and provision in the UK is inadequate.

I was told by a psychiatrist recently that the distinction between endogenous and reactive depression is not considered vaild any more. I think the argument was depression is chemical imbalance, whether in response to a situation or not.

Obviously he would not medicate if simple situational changes would solve the problems but he seemed to say that antidepressants were valid in both cases.

Situational depresssion can cause a chemical imbalance if it goes on too long. In those circumstances medication might help.

There is a difference between what is normal human emotion and what is pathological. Ie. I felt very low when I was a victim of a serious sexual assult at 19. In the days afterwards I just wanted to die. I had cracked ribs, my toxic parents thought I was whore and I was black and blue all over. I don't believe that medication in that situation would have been right at that point.

However when I experienced postnatal depression where I had no reason to be depressed then medication worked well. Infact it was essential for my recovery as chemical inbalance was the cause of the depression.

It is a situation a bit like the chicken and the egg. Its a real pity there is no blood test to measure the chemical balance in the brain.