COMMENTARY

Recognizing Minor Depression

Joshua Fogel, PhD

Disclosures

August 09, 2006

In This Article

Introduction

According to the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV), depressive mood can be seen in a number of psychiatric and medical disorders.[1] Some physiologic effects of general medical conditions or medications can result in a diagnosis of mood disorders attributed to these causes. Involvement of manic symptoms can prompt a diagnosis of bipolar or cyclothymic disorder; and involvement of psychotic symptoms can result in a diagnosis of bipolar or schizoaffective disorder.

Individuals may also experience depressed moods that do not involve any of the above symptoms or conditions. In these situations, the available DSM-IV psychiatric diagnoses or conditions are major depressive disorder (MDD), dysthymic disorder, adjustment disorders (ie, with depressed mood or with mixed anxiety and depressed mood), bereavement, or depressive disorder not otherwise specified (NOS).[1] According to the DSM-IV, the standard approach is to first determine whether the patient is experiencing a major depressive episode. The diagnosis of MDD requires a number of criteria, including the presence of 5 of 9 specified depressive symptoms for a period of at least 2 weeks. One of these symptoms should be either depressed mood or loss of interest or pleasure. When a major depressive episode is present, one considers the diagnosis of MDD.

When a major depressive episode is not present, one considers other diagnoses or conditions. The hallmark of dysthymic disorder is a depressed mood existing for a period of at least 2 years. If the depressed mood is linked to a stressor, one considers adjustment disorders; and if linked to a death, one considers bereavement. When clinically significant depressive symptoms do not meet any of the above criteria, one considers depressive disorder NOS.

But what happens when an individual has 2 to 4 depressive symptoms (including either depressed mood or loss of interest or pleasure) during a 2-week period, but has not had these symptoms for 2 years, and no particular event(s) can be linked to these depressive symptoms? Currently the individual would be diagnosed with depressive disorder NOS. But is there something more to this diagnosis severity than the catch-all category of depressive disorder NOS? The DSM-IV discusses what it calls "minor depression" (miD), which is characterized by the presence of 2 to 4 depressive symptoms during a 2-week period, and requires one of these symptoms to be either depressed mood or loss of interest or pleasure. A history of a variety of disorders, including MDD, excludes an individual from this category.[1] At the time of publication, however, the authors of the DSM-IV concluded that there was insufficient information to include miD as a formal diagnosis.[1]

This article reviews the prevalence, the depression continuum, and the impact of miD. It concludes with assessment and treatment considerations.

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