What role do pharmacological treatments play in the management of adjustment disorder, and when should they be considered?

Role of pharmacological treatments in adjustment disorder: Pharmacological treatments are not the first-line management for adjustment disorder and are generally considered only when psychological interventions are not preferred, not feasible, or have been ineffective. Medication may be used to target specific symptoms such as significant depression, anxiety, or severe distress that impair functioning.

Circumstances for considering pharmacological treatment: Pharmacological treatment should be considered if the person:

• Expresses a preference for drug treatment over psychological therapies.
• Is unable or unwilling to engage in psychological treatments.
• Has significant comorbid depression or anxiety symptoms that prevent benefit from psychological therapies.
• Has had a poor response to psychological treatments.
• May benefit from medication as an adjunct to psychological therapies to manage severe symptoms.

Selective serotonin reuptake inhibitors (SSRIs) are typically the first choice due to their safety and tolerability profile. Antidepressants such as SSRIs or venlafaxine may be used, and antipsychotics like risperidone should only be initiated and monitored under specialist mental health supervision if indicated. Treatment decisions should involve shared decision-making, considering patient preferences, potential side effects, and risk factors such as suicide risk. Regular monitoring is essential, especially early in treatment, to assess efficacy and adverse effects.