Adjustment Disorder Treatment
Psychotherapy is the main treatment for adjustment disorder. Pharmacotherapy and self-care can be used as adjuncts when indicated by symptom severity and functional impairment. [1][2]
Medication Selection Algorithm
- No medication is recommended as a stand-alone treatment for adjustment disorder in typical cases. [1]
- When pharmacotherapy is used, treatment is directed toward prominent target symptoms (for example, depressed mood, anxiety, insomnia) and is typically time-limited. [1][2]
- Antidepressant medications have been used with some success for depressive symptoms in adjustment disorder. [1]
- Benzodiazepines are sometimes used for insomnia or anxiety symptoms in adjustment disorder, but evidence of efficacy is mixed and risks include dependence and cognitive adverse effects. [1]
- Selective serotonin reuptake inhibitors have stronger evidence when the eventual diagnosis is an anxiety disorder or a depressive disorder rather than adjustment disorder. [1]
Key Evidence Supporting This Recommendation
Evidence supporting psychotherapy efficacy in adjustment disorder is limited, partly because adjustment disorder is clinically heterogeneous. [1]
Evidence supporting pharmacotherapy efficacy in adjustment disorder is also limited. [1]
Psychotherapy Modality
Psychotherapeutic interventions may include cognitive-behavioral therapy, psychodynamic psychotherapy, family therapy, interpersonal therapy, and supportive psychotherapy. [1]
Supportive, skills-based approaches are used to improve coping and restore functioning after the stressor. [2]
Trauma-informed psychotherapy is suggested to be helpful when adjustment symptoms are linked to traumatic stress. [1]
Self-Care and Ongoing Stressors
Self-care is emphasized as important for recovery and includes attention to personal safety, physical health, mindfulness, maintenance of a daily schedule, and engagement with community supports when feasible. [1]
Recovery is less likely to proceed when the stressful event is recurring and when surrounding conditions remain unsafe. [1]
Treatment Initiation Thresholds
Treatment is indicated when emotional or behavioral symptoms produce marked distress out of proportion to the stressor and/or significant social, occupational, or other functional impairment. [1]
Brief treatment is commonly sufficient, with longer treatment considered when symptoms persist or ongoing stress remains present. [2]
Common Pitfalls to Avoid
Benzodiazepines should be used cautiously due to dependence risk, misuse risk, and potential for acute cognitive worsening. [1]
Stopping antidepressant or other prescribed psychotropic medication abruptly without clinical guidance is discouraged because discontinuation can cause physical reactions for some agents. [2]
Target Outcomes of Therapy
Treatment targets improvement in distress and coping and a return toward a typical routine and social and occupational functioning. [2]
Symptoms of adjustment disorder typically begin within days of the stressful event and resolve within 6 months after the stressor and its consequences end. [1]