Minor depressive disorder

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Minor depressive disorder, also known as minor depression, is a mood disorder that does not meet the full criteria for major depressive disorder but at least two depressive symptoms are present for a long time. These symptoms can be seen in many different psychiatric and mental disorders, which can lead to more specific diagnoses of an individual's condition. However, some of the situations might not fall under specific categories listed in the Diagnostic and Statistical Manual of Mental Disorders . Minor depressive disorder is an example of one of these nonspecific diagnoses, as it is a disorder classified in the DSM-IV-TR under the category Depressive Disorder Not Otherwise Specified (DD-NOS). [1] The classification of NOS depressive disorders is up for debate. Minor depressive disorder as a term was never an officially accepted term, but was listed in Appendix B of the DSM-IV-TR. This is the only version of the DSM that contains the term, as the prior versions and the most recent edition, DSM-5, does not mention it. [2] [3]

Contents

A person is considered to have minor depressive disorder if they experience two to four depressive symptoms, with one of them being either depressed mood or loss of interest or pleasure, during a two-week period. The person must not have experienced the symptoms for two years and there must not have been one specific event that caused the symptoms to arise. Although not all cases of minor depressive disorder are deemed in need of treatment, some cases are treated similarly to major depressive disorder. This treatment includes cognitive behavioral therapy (CBT), anti-depressant medication, and combination therapy. A lot of research supports the notion that minor depressive disorder is an early stage of major depressive disorder, or that it is simply highly predictive of subsequent major depressive disorder. [2]

Signs and symptoms

Minor depressive disorder is very similar to major depressive disorder in the symptoms present. Generally, a person's mood is affected by thoughts and feelings of being sad or down on themself or by a loss of interest in nearly all activities. People can experience ups and downs in their life everyday where an event, action, stress or many other factors can affect their feelings on that day. However, depression occurs when those feelings of sadness persist for longer than a few weeks. [4]

A person is considered to have minor depressive disorder if they experience two to four depressive symptoms during a two-week period. The Diagnostic and Statistical Manual of Mental Disorders lists the major depressive symptoms. Depressed mood most of the day and/or loss of interest or pleasure in normal activities must be experienced by the individual to be considered to have minor depressive disorder. Without either of these two symptoms, the disorder is not classified as minor depressive disorder. Other depressive symptoms include significant weight loss or weight gain without trying to diet (an increase/decrease in appetite can provide clues as well), insomnia or hypersomnia, psychomotor agitation or psychomotor retardation, fatigue or loss of energy, and feelings of worthlessness or excessive guilt.

All of these signs can compound on each other to create the last major symptom group of minor depressive disorder: thoughts of death, suicidal thoughts, plans to commit suicide, or a suicide attempt. [5]

Minor depressive disorder differs from major depressive disorder in the number of symptoms present with five or more symptoms necessary for a diagnosis of major depressive disorder. Both disorders require either depressed mood or loss of interest or pleasure in normal activities to be one of the symptoms and the symptoms need to be present for two weeks or longer. Symptoms also must be present for the majority of the length of a day and present for a majority of the days in the two-week period. Diagnosis can only occur if the symptoms cause "clinically significant distress or impairment". [1] Dysthymia consists of the same depressive symptoms, but its main differentiable feature is its longer-lasting nature as compared to minor depressive disorder. Dysthymia was replaced in the DSM-5 by persistent depressive disorder, which combined dysthymia with chronic major depressive disorder. [3]

Treatment

Treatment of minor depressive disorder has not been studied as extensively as major depressive disorder. Although there are often similarities in the treatments used, there are also differences in what may work better for the treatment of minor depressive disorder. Some third-party payers do not pay to cover treatment for minor depressive disorder. [2]

The leading treatment techniques for minor depressive disorder are the use of antidepressants and therapy. Typically, patients with minor depression were treated by watchful waiting, prescribed antidepressants, and given brief supportive counseling, but Problem-Solving Treatment for Primary Care (PST-PC) is a Cognitive-Behavioral Therapy that has gained popularity. In one study, PST-PC and Paroxetine, an antidepressant, were shown to be equally effective in significantly reducing symptoms. [6] In another study, PST-PC was compared with the more typical care of the time and shown to reduce symptoms more quickly. [7] Although the use of antidepressants has been widely used, not all agree that it is an appropriate treatment for some minor depression disorder settings. [8]

Another alternative that has been researched is the use of St. John's wort (Hypericum perforatum). This herbal treatment has been studied by various groups with various results. [9] Some studies show evidence of the treatment being helpful to treat minor depression, but others show that it does no better than the placebo. [10] [11]

History

At its core, minor depressive disorder is the same illness as major depressive disorder with its symptoms being less pronounced. This ties its history closely to that of major depressive disorder. Depression in the past has largely been shrouded in mystery, as its causes and appropriate treatment were largely unknown. By the 1950s, it was clear that depression could be both a mental and largely physical disease, thus being able to be treated through both psychotherapy and medication. When the DSM-IV-TR was created and major depressive disorder was spelled out more clearly, there still seemed to be an uncategorized range of depression. People in this category did not have a complete set of symptoms in order to be diagnosed with major depression, but still were undoubtedly depressed. The DSM-IV-TR solution to this uncatergorized range of depression was to create Depressive Disorder Not Otherwise Specified (NOS). This group of not specified disorders included minor depressive disorder. In the recent switch to the current DSM-5, minor depressive disorder was dropped from the list of depression disorders.

With the disappearance of minor depressive disorder from the DSM-5, there has been confusion between dysthymic disorder, persistent depressive disorder, and minor depressive disorder. Dysthymic disorder was a subsection in the DSM-IV-TR under mood disorders. In the DSM-5, dysthymia is relabeled as "Persistent Depressive Disorder (Dysthymia)". There are differences between persistent depressive disorder and minor depressive disorder including: length of symptom presence, the number of symptoms present, and recurrent periods. [3] The diagnosis of minor depressive disorder has historically been harder to outline, which could have perhaps lead to the disappearance of the disorder. The DSM-IV-TR includes a statement detailing the difficulty of diagnosis, "symptoms meeting research criteria for minor depressive disorder can be difficult to distinguish from periods of sadness that are an inherent part of everyday life". [1]

Related Research Articles

Bipolar I disorder is a type of bipolar spectrum disorder characterized by the occurrence of at least one manic episode, with or without mixed or psychotic features. Most people also, at other times, have one or more depressive episodes. Typically, these manic episodes can last at least 7 days for most of each day to the extent that the individual may need medical attention, while the depressive episodes last at least 2 weeks.

<span class="mw-page-title-main">Major depressive disorder</span> Mood disorder

Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Introduced by a group of US clinicians in the mid-1970s, the term was adopted by the American Psychiatric Association for this symptom cluster under mood disorders in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), and has become widely used since. The disorder causes the second-most years lived with disability, after lower back pain.

<span class="mw-page-title-main">Melancholia</span> Historical view of extreme depression

Melancholia or melancholy is a concept found throughout ancient, medieval, and premodern medicine in Europe that describes a condition characterized by markedly depressed mood, bodily complaints, and sometimes hallucinations and delusions.

<span class="mw-page-title-main">Mood disorder</span> Mental disorder affecting the mood of an individual, over a long period of time

A mood disorder, also known as an affective disorder, is any of a group of conditions of mental and behavioral disorder where the main underlying characteristic is a disturbance in the person's mood. The classification is in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD).

Schizoaffective disorder is a mental disorder characterized by symptoms of both schizophrenia (psychosis) and a mood disorder - either bipolar disorder or depression. The main diagnostic criterion is the presence of psychotic symptoms for at least two weeks without prominent mood symptoms. Common symptoms include hallucinations, delusions, disorganized speech and thinking, as well as mood episodes. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, bipolar I disorder, schizophreniform disorder, or schizophrenia. This is a problem as treatment and prognosis differ greatly for most of these diagnoses. Many people with schizoaffective disorder have other mental disorders including anxiety disorders.

Premenstrual dysphoric disorder (PMDD) is a mood disorder characterized by emotional, cognitive, and physical symptoms. PMDD causes significant distress or impairment in menstruating women during the luteal phase of the menstrual cycle. The symptoms occur in the luteal phase, improve within a few days after the onset of menses, and are minimal or absent in the week after menses. PMDD has a profound impact on a woman’s quality of life and dramatically increases the risk of suicidal ideation and even suicide attempts. Many women of reproductive age experience discomfort or mild mood changes prior to menstruation. However, 5–8% experience severe premenstrual syndrome causing significant distress or functional impairment. Within this population of reproductive age, some will meet the criteria for PMDD.

<span class="mw-page-title-main">Depression (mood)</span> State of low mood and aversion to activity

Depression is a mental state of low mood and aversion to activity. It affects about 3.5% of the global population, or about 280 million people of all ages. Depression affects a person's thoughts, behavior, feelings, and sense of well-being. Experiences that would normally bring a person pleasure or joy give reduced pleasure or joy, and the afflicted person often experiences a loss of motivation or interest in those activities.

Adjustment disorder is a maladaptive response to a psychosocial stressor. It is classified as a mental disorder. The maladaptive response usually involves otherwise normal emotional and behavioral reactions that manifest more intensely than usual, causing marked distress, preoccupation with the stressor and its consequences, and functional impairment.

Dysthymia, also known as persistent depressive disorder (PDD), is a mental and behavioral disorder, specifically a disorder primarily of mood, consisting of similar cognitive and physical problems as major depressive disorder, but with longer-lasting symptoms. The concept was used by Robert Spitzer as a replacement for the term "depressive personality" in the late 1970s.

Dysphoria is a profound state of unease or dissatisfaction. It is the semantic opposite of euphoria. In a psychiatric context, dysphoria may accompany depression, anxiety, or agitation.

Atypical depression is defined in the DSM-IV as depression that shares many of the typical symptoms of major depressive disorder or dysthymia but is characterized by improved mood in response to positive events. In contrast to those with atypical depression, people with melancholic depression generally do not experience an improved mood in response to normally pleasurable events. Atypical depression also often features significant weight gain or an increased appetite, hypersomnia, a heavy sensation in the limbs, and interpersonal rejection sensitivity that results in significant social or occupational impairment.

A major depressive episode (MDE) is a period characterized by symptoms of major depressive disorder. Those affected primarily exhibit a depressive mood for at least two weeks or more, and a loss of interest or pleasure in everyday activities. Other symptoms can include feelings of emptiness, hopelessness, anxiety, worthlessness, guilt, irritability, changes in appetite, difficulties in concentration, difficulties remembering details, making decisions, and thoughts of suicide. Insomnia or hypersomnia and aches, pains, or digestive problems that are resistant to treatment may also be present.

Depressive disorder not otherwise specified (DD-NOS) is designated by the code 311 in the DSM-IV for depressive disorders that are impairing but do not fit any of the officially specified diagnoses. According to the DSM-IV, DD-NOS encompasses "any depressive disorder that does not meet the criteria for a specific disorder." In the DSM-5, it is called unspecified depressive disorder.

Depressive personality disorder is a psychiatric diagnosis that denotes a personality disorder with depressive features.

<span class="mw-page-title-main">Bipolar disorder in children</span>

Bipolar disorder in children, or pediatric bipolar disorder (PBD), is a rare mental disorder in children and adolescents. The diagnosis of bipolar disorder in children has been heavily debated for many reasons including the potential harmful effects of adult bipolar medication use for children. PBD is similar to bipolar disorder (BD) in adults, and has been proposed as an explanation for periods of extreme shifts in mood called mood episodes. These shifts alternate between periods of depressed or irritable moods and periods of abnormally elevated moods called manic or hypomanic episodes. Mixed mood episodes can occur when a child or adolescent with PBD experiences depressive and manic symptoms simultaneously. Mood episodes of children and adolescents with PBD are different from general shifts in mood experienced by children and adolescents because mood episodes last for long periods of time and cause severe disruptions to an individual's life. There are three known forms of PBD: Bipolar I, Bipolar II, and Bipolar Not Otherwise Specified (NOS). The average age of onset of PBD remains unclear, but reported age of onset ranges from 5 years of age to 19 years of age. PBD is typically more severe and has a poorer prognosis than bipolar disorder with onset in late-adolescence or adulthood.

Bipolar II disorder (BP-II) is a mood disorder on the bipolar spectrum, characterized by at least one episode of hypomania and at least one episode of major depression. Diagnosis for BP-II requires that the individual must never have experienced a full manic episode. Otherwise, one manic episode meets the criteria for bipolar I disorder (BP-I).

What was previously known as melancholia and is now known as clinical depression, major depression, or simply depression and commonly referred to as major depressive disorder by many health care professionals, has a long history, with similar conditions being described at least as far back as classical times.

Late-life depression refers to depression occurring in older adults and has diverse presentations, including as a recurrence of early-onset depression, a new diagnosis of late-onset depression, and a mood disorder resulting from a separate medical condition, substance use, or medication regimen. Research regarding late-life depression often focuses on late-onset depression, which is defined as a major depressive episode occurring for the first time in an older person.

Cyclothymia, also known as cyclothymic disorder, psychothemia / psychothymia, bipolar III, affective personality disorder and cyclothymic personality disorder, is a mental and behavioural disorder that involves numerous periods of symptoms of depression and periods of symptoms of elevated mood. These symptoms, however, are not sufficient to indicate a major depressive episode or a manic episode. Symptoms must last for more than one year in children and two years in adults.

<span class="mw-page-title-main">Disruptive mood dysregulation disorder</span> Medical condition

Disruptive mood dysregulation disorder (DMDD) is a mental disorder in children and adolescents characterized by a persistently irritable or angry mood and frequent temper outbursts that are disproportionate to the situation and significantly more severe than the typical reaction of same-aged peers. DMDD was added to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) as a type of depressive disorder diagnosis for youths. The symptoms of DMDD resemble many other disorders, thus a differential includes attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), anxiety disorders, and childhood bipolar disorder, intermittent explosive disorder (IED), major depressive disorder (MDD), and conduct disorder.

References

  1. 1 2 3 Diagnostic and Statistical Manual of Mental Disorders (PDF) (4th ed.). American Psychological Association. 1994. pp. 320–350. Archived from the original (PDF) on 16 December 2018. Retrieved 17 April 2016.
  2. 1 2 3 Fils, J. M.; Penick, E. C.; Nickel, E. J.; Othmer, E.; DeSouza, C.; Gabrielli, W. F.; Hunter, E. E. (2010). "Minor Versus Major Depression: A Comparative Clinical Study". The Primary Care Companion to the Journal of Clinical Psychiatry. 12 (1): PCC.08m00752. doi:10.4088/PCC.08m00752blu. PMC   2882809 . PMID   20582293.
  3. 1 2 3 Diagnostic and Statistical Manual of Mental Disorders (PDF) (5th ed.). American Psychological Association. 2013. pp. 168–171. Retrieved 17 April 2016.
  4. ↑ "Depression" (PDF). National Institute of Mental Health. Archived from the original on July 27, 2011. Retrieved 18 April 2016.{{cite web}}: CS1 maint: unfit URL (link)
  5. ↑ Doe, John. "Checklist for Major Depression (based on DSM IV)" (PDF). alaap.org. Pediatric Practice, PC. Archived from the original (PDF) on 2 June 2016. Retrieved 18 April 2016.
  6. ↑ Barrett, J. E.; Williams, J. J.; Oxman, T.E.; Frank, E.; Katon, W.; Sullivan, M.; Sengupta, A. S. (2001). "Treatment of dysthymia and minor depression in primary care: A randomized trial in patients aged 18 to 59 years". The Journal of Family Practice. 50 (5): 405–412.
  7. ↑ Oxman, T. E.; Hegel, M. T.; Hull, J. G.; Dietrich, A. J. (2008). "Problem-solving treatment and coping styles in primary care for minor depression". Journal of Consulting and Clinical Psychology. 76 (6): 933–943. doi:10.1037/a0012617. PMC   2593861 . PMID   19045962.
  8. ↑ Hegerl, U.; Schonknecht, P.; Mergl, R. (2012). "'Are antidepressants useful in the treatment of minor depression: A critical update of the current literature': Erratum". Current Opinion in Psychiatry. 25 (2): 163. doi: 10.1097/YCO.0b013e328351053d .
  9. ↑ "Treatment for Minor Depression". National Institute of Mental Health. National Institutes of Health. Retrieved 18 April 2016.
  10. ↑ "St. John's Wort for Treating Depression". webmd. WebMD. Retrieved 18 April 2016.
  11. ↑ Rapaport, M. H.; Nierenberg, A. A.; Howland, R.; Dording, C.; Schettler, P. J.; Mischoulon, D. (2011). "The treatment of minor depression with St. John's wort or citalopram: Failure to show benefit over placebo". Journal of Psychiatric Research. 45 (7): 931–941. doi:10.1016/j.jpsychires.2011.05.001. PMC   3137264 . PMID   21632064.
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