Treating adjustment disorder in adults and young people
The primary intervention for adjustment disorder is addressing the triggering psychosocial stressor, if feasible. Although there is little evidence to guide treatment, psychosocial interventions are frequently helpful, including psychoeducation, relaxation strategies, problem solving, stress management, and accommodation and financial guidance. Some patients may benefit from short-term counselling or supportive psychotherapy (eg cognitive behavioural therapy (CBT), psychodynamic psychotherapy).
Pharmacotherapy has a limited role in managing adjustment disorder—do not use antidepressants because they are not effective.
If difficulty sleeping is a significant feature, see Insomnia for treatment.
If anxiety symptoms are severe, cause significant functional impairment or have not adequately responded to psychosocial interventions, consider short-term use of a benzodiazepine. However, there is an absence of high-quality evidence for benzodiazepine benefit, and benzodiazepine use is associated with increased risk of falls, memory problems, motor vehicle accidents, daytime sedation and dependence. These risks are of particular concern in older people and people with a history of problem substance use; in these people, harms of benzodiazepine use may outweigh the benefits (see Principles of benzodiazepine use in anxiety disorders). Intermittent use for severe exacerbations of anxiety is preferable to continuous treatment.
If short-term use of a benzodiazepine is required for anxiety associated with adjustment disorder, use:
1 clonazepam 250 to 500 micrograms orally, as a single dose. If required, repeat once after 2 hours. Use for up to 2 weeks adjustment disorder clonazepam clonazepam clonazepam
OR
1 diazepam 2 to 5 mg orally, as a single dose. If required, repeat once after 2 hours. Use for up to 2 weeks adjustment disorder diazepam diazepam diazepam
OR
1 lorazepam 0.5 to 1 mg orally, as a single dose. If required, repeat once after 2 hours. Use for up to 2 weeks1. adjustment disorder lorazepam lorazepam lorazepam
If intermittent dosing is insufficient, use short-term continuous treatment at the lowest effective dose. Use:
1 clonazepam 250 to 500 micrograms orally, once or twice daily, for up to 2 weeks clonazepam clonazepam clonazepam
OR
1 diazepam 2 to 5 mg orally, once or twice daily, for up to 2 weeks diazepam diazepam diazepam
OR
1 lorazepam 0.5 to 1 mg orally, once or twice daily, for up to 2 weeks1. lorazepam lorazepam lorazepam
If the patient is acutely agitated or has an acute behavioural disturbance, if possible use nonpharmacological measures to reduce the risk of harm. If the patient remains acutely agitated and is at risk of harming themselves or others, see the advice on drug therapy for acute behavioural disturbance in adults or older people.
If symptoms of adjustment disorder are severe and persistent, and have not responded to treatment, consider alternative diagnoses such as major depression or an anxiety disorder.
When evaluating treatment options for a young person, also consider:
- there are few data on psychotropic use in young people because young people are poorly represented in clinical trials
- if pharmacotherapy is used, it should ideally be started by a clinician with expertise in using psychotropics in young people.
For treatment considerations for females of childbearing potential, including advice on contraception, preconception planning and psychotropic use, see here.
For considerations in managing anxiety disorders such as adjustment disorder during the perinatal period, see here or for considerations in partners, see here.