Special ArticleClinically Significant Non-Major Depression: Old Concepts, New Insights
Section snippets
Nosological and Diagnostic Complexities
In current psychiatric practice and research in both elderly patients and younger adult populations, two principal approaches define depression: 1) depressive symptoms; and 2) more specific depressive illnesses or disorders defined in terms of duration, number, and type of depressive symptoms. Most nonpsychiatrists typically regard depression in terms of the first construct, whereas psychiatrists apply the second.8 Most studies demonstrate that patients with depressive symptoms, even in the
Minor Depression
Minor Depressive Disorder is now included in the DSM-IV as a “potential category,” with a set of diagnostic research criteria proposed for further studies.10 The essential feature of minor depression is one or more periods of depressive symptoms that are identical to major depressive episodes in duration (2 weeks or longer), but which involve fewer symptoms and less impairment. An episode involves either a depressed mood or loss of interest or pleasure in nearly all activities. In total, at
DOES GERIATRIC “NON-MAJOR DEPRESSION” DIFFER FROM DEPRESSION IN YOUNGER ADULTS?
Some similarities and differences exist in phenomenology and disease course of depression in elderly patients and in younger adults.49, 50, 51 Unlike major depression, with its preponderance of biological and melancholic features, the clinical presentation of minor depression is variable.52 Blazer and colleagues9 identified a symptom cluster profile unique to people over 60 years old, characterized by depressed mood, psychomotor retardation, poor concentration, constipation, and poor
TREATMENT
To date, studies of treatment of non-major depressive disorders are limited in number. Very little is known about treatment strategies in clinically significant non-major depression. Most existing studies focus on dysthymia and minor depression in primary care.39, 46, 106, 107
Descriptive studies have established that in treating depression, primary care providers use one or more of three modalities: watchful waiting, medication, and referral to the specialty sector.108 Used most commonly,
CONCLUSIONS
There are similarities and differences in the manifestations of clinically significant depressive disorders. There is an emerging consensus from epidemiological, longitudinal, and genetic studies supporting the idea of a continuum of depressive disorders, ranging from the very mild “subthreshold” to major unipolar and bipolar disorders. Evidence from neuroimaging and neuropsychological studies lends additional support to this thesis. All forms of clinically significant depression are associated
References (123)
- et al.
Subthreshold depression in the elderly: qualitative or quantitative distinction?
Compr Psychiatry
(2000) - et al.
A statistical analysis of the classification of depression in a mixed community and clinical sample
J Affect Disord
(1989) - et al.
Depressive spectrum diagnoses
Compr Psychiatry
(2000) - et al.
The depressive spectrum: diagnostic classification and course
J Affect Disord
(1997) - et al.
The role and clinical significance of subsyndromal depressive symptoms (SSD) in unipolar major depressive disorder
J Affect Disord
(1997) Pleiomorphic expression of unipolar depressive disease: summary of the 1996 CINP President's Workshop
J Affect Disord
(1997)- et al.
Neurological correlates of depressive symptoms in Alzheimer's disease and vascular dementia
J Affect Disord
(1999) - et al.
Psychiatric symptoms in progressive supranuclear palsy
Psychosomatics
(1995) Psychiatric diagnoses and inconsistent results of association studies in behavioral genetics
Med Hypotheses
(2000)Depressive personality in the relatives of outpatients with dysthymic disorder and episodic major depressive disorder and normal controls
J Affect Disord
(1999)
Depression-spectrum disease with and without depression in first-degree relatives
J Affect Disord
APOE is a major susceptibility gene for Alzheimer's disease
Curr Opin Biotechnol
Association of the APOE epsilon-4 allele with clinical subtypes of late-life depression
Biol Psychiatry
Apolipoprotein-E and white-matter hyperintensities in late-life depression
Am J Geriatr Psychiatry
Apolipoprotein-E genotype and noncognitive symptoms in Alzheimer's disease
Biol Psychiatry
A longitudinal study of apolipoprotein-E genotype and depressive symptoms in community-dwelling older adults
Am J Geriatr Psychiatry
Diagnosis and treatment of depression in late life: consensus statement update
JAMA
Consequences of major and minor depression in later life: a study of disability, well-being, and service utilization
Psychol Med
Minor depression: a review of the literature
Int J Psychiatry Med
Differences in psychosocial and health correlates of major and minor depression in medically ill older adults
J Am Geriatr Soc
Socioeconomic burden of subsyndromal depressive symptoms and major depression in a sample of the general population
Am J Psychiatry
Minor depression in the aged: concepts, prevalence, and optimal management
Drugs Aging
Diagnostic and Statistical Manual of Mental Disorders
Depression, disability days, and days from work in a prospective epidemiological survey
JAMA
The functioning and well-being of depressed patients: results from the Medical Outcomes Study
JAMA
Clinical validity
Psychol Med
What is a case?
Arch Gen Psychiatry
Clinical and etiological heterogeneity of mood disorders in elderly patients
The limits of psychiatric knowledge and the problem of classification
Why Psychiatry Is A Branch of Medicine
The DSM-IV (Depression) classification: to be or not to be?
J Nerv Ment Dis
Inflationary tendencies in judging the yield of depression research
Biol Psychiatry
Diagnosis, the rate-limiting factor of biological depression research
Biol Psychiatry
Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia
Am J Psychiatry
Common Mental Disorders: A Bio-Social Model
The relationship between symptoms and diagnoses of minor psychiatric disorder in general practice
Psychol Med
Diagnosis of dementia and depression: a latent trait analysis of their performance
Psychol Med
Age differences in the symptoms of depression: a latent trait analysis
J Gerontol Psychol Sci
The epidemiology of mental disorders in middle-age and late-life: conceptual issues
Epidemiol Rev
Sadness in older persons: 13-year follow-up of a community sample in Baltimore, Maryland
Psychol Med
Clinical diagnosis: a marker for disease?
J Nerv Ment Dis
Subtyping depression, I: is psychomotor disturbance necessary and sufficient to the definition of melancholia?
Psychol Med
Subtyping depression, II: clinical distinction of psychotic depression and non-psychotic melancholia
Psychol Med
Subtyping depression, III: development of a clinical algorithm for melancholia and comparison with other diagnostic measures
Psychol Med
The structure and stability of common mental disorders
Arch Gen Psychiatry
A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders
Arch Gen Psychiatry
Minor and subsyndromal depression: functional disability worth treating (editorial; comment)
J Am Geriatr Soc
Depression in medically ill hospitalized older adults: prevalence, characteristics, and course of symptoms according to six diagnostic schemes
Am J Psychiatry
Cited by (128)
Sex-specificities in anxiety and depressive symptoms across the lifespan and their links with multimodal neuroimaging
2022, Journal of Affective DisordersVertex-wise examination of depressive symptom dimensions and brain volumes in older adults
2017, Psychiatry Research - NeuroimagingDepression among older adults with diabetes mellitus
2015, Clinics in Geriatric MedicineMultimodal MRI markers support a model of small vessel ischemia for depressive symptoms in very old adults
2014, Psychiatry Research - NeuroimagingThe role of spousal loss in the development of depressive symptoms in the elderly - Implications for diagnostic systems
2014, Journal of Affective Disorders
Dr. Kumar is at the UCLA Department of Psychiatry and Biobehavioral Sciences.
This work was supported in part by the NARSAD Young Investigator Award and K23-MH 01948 to Dr. Lavretsky, and grants MH55115, MH 61567, and KO2-MH02043 (to Dr. Kumar).