A major progressivemajor depressive episode is often seen in the months following an injury as the patient deals with appreciable losses to income and often to mobility and almost always losses to comfort.
Often, however, a less disruptive, *adjustment disorder* may occur during the first six months, referred to as _adjustment disorder with depressed mood (or with anxiety and depressed mood). Few of us are prepared for a drastic reduction in income and increased pain with uncertain future.
As time passes, most individuals adapt. However, for some, the depression becomes a waxing and waning disorder which we call _dysthymic disorder._ Such individuals can often list the losses that have occurred for them, their fear of the future, their negative expectancies regarding life that is to come and their sense of helplessness to do anything about it.
In all cases, these are treatable conditions. It is critical that symptoms of depressed not be confused with _just one more symptom_ of the injury.
Depression is a common response to injury and readily treated. But very often the symptoms of depression are ignored whereupon they increase and become the central problem in case management.