Minor Versus Major Depression: A Comparative Clinical Study

Minor Versus Major Depression: 

A Comparative Clinical Study

To examine whether minor depression differs from major depression in clinically relevant ways.

Method:

Structured interviews, Symptom Checklist-90-Revised (SCL-90-R) scores, and physicians' treatment recommendations were obtained systematically from 1,458 admissions to an outpatient teaching clinic during a 5-year period from 1981 to 1986. Of these, 1,002 (69%) satisfied inclusive DSM-III lifetime criteria for a major depressive episode. Of the 456 outpatients who did not formally satisfy criteria for a major depressive episode, 79 (17%) acknowledged significant depressive symptoms that caused major interference in their lives. These 79 outpatients were classified as suffering from minor depression.

Outcome:

No gender or other sociodemographic differences were found between the 2 outpatient groups except that the minor depression group had achieved a higher level of education. No differences were found for a family history of psychiatric illness among first-degree relatives, including a family history of depression. Ratings of childhood unhappiness/problems did not distinguish the 2 groups. The major depression group endorsed more lifetime depressive symptoms and met criteria for more co-occurring disorders, principally mania and the anxiety disorders. The group with major depression reported poorer psychosocial functioning when first seen and more past psychiatric treatment. The Symptom Checklist-90-Revised (SCL-90-R) profile was significantly elevated in both groups. The type of initial treatment recommended did not distinguish the major from minor depression groups.

Conclusions:

Minor depression seems to represent the same illness as major depression but in a less severe form that, nevertheless, requires the attention of professional health care providers in both primary and specialized care settings.

Many individuals who seek help from mental health professionals suffer from significant depressive symptoms but do not formally satisfy the DSM inclusive criteria for a diagnosis of major depression. In the DSM-III and DSM-IV, the diagnostic option for individuals suffering from subthreshold or subsyndromal depression is “NOS” or “depression, not otherwise specified.” However, the “depression, NOS” designation covers other subthreshold conditions including premenstrual dysphoric disorder, recurrent brief depressive disorder, postpsychotic depressive disorder of schizophrenia, and major depressive episode superimposed on a delusional disorder. Many clinicians find the NOS designation unsatisfactory, and some third-party payers will not cover a NOS diagnosis. Several clinicians have proposed the adoption of a unique term and specific diagnostic code for subthreshold conditions, such as minor depression.

Minor depression is one of the proposed, but not currently accepted, subthreshold conditions . It is defined as the presence of at least 2, but fewer than 5, depressive symptoms (1 symptom must be either depressed mood or loss of interest) during the same 2-week period, with no history of a major depressive episode or dysthymia. In contrast, major depression is defined in both the DSM-III and DSM-IV as the presence of either depressed mood or loss of interest or irritability (if 18 years or younger) with 5 or more depressive symptoms, lasting at least 2 weeks, with no history of a manic, hypomanic, or mixed episode. A criterion for both major and minor depression includes the requirement that depressive symptoms significantly impair the individual's ability to function.

Clinical Points

♦ Minor depression seems to be a milder presentation on a continuum of severity of the same illness called major depression and is highly predictive of the latter.

♦ Primary care settings are commonly the first point of contact for depressed patients where monitoring and periodic reassessment of depressive symptoms can be done.

♦ When symptoms of minor depression persist or worsen or when there is increasing functional impairment, antidepressant medication should be considered.

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