Background: The two essential features of minor depression are that it has fewer symptoms than major depression and that it is less chronic than dysthymia. This study describes the clinical features and functioning of outpatients with minor depression. Methods: Subjects with minor depression (with and without a prior history of major depression) were recruited through clinical referrals and community advertising. Assessments included the Structured Clinical Interview for DSM-IV (SCID), the 17-item Hamilton Rating Scale for Depression (HAM-D), the Inventory of Depressive Symptomatology-Self Report (IDS-SR) and Clinician Rated (IDS-C) scales, the Global Assessment of Functioning (GAF) scale, the Medical Outcomes Study 36-item Short-Form scale (MOS), and the Clinical Global Impressions Severity Scale (CGI). Data from previously published studies of major depression, minor depression, and normal controls were compared to our data set. Results: Minor depression is characterized primarily by mood and cognitive symptoms rather than vegetative symptoms; the functional impairment associated with minor depression is as severe as for major depression in several areas; minor depression occurs either independently of major depression or as a stage of illness during the long-term course of major depression, and minor depression patients with and without a history of major depression have similar levels of depressive severity and functional impairment. Conclusions: These findings support the notion that minor depression is an important clinical entity that fits within the larger spectrum of depressive disorders.

Keywords:
Minor depression, Depressive disorders, Psychosocial function, Depressive symptoms
1.
Judd LL, Rapaport MH, Paulus MP, Brown JL: Subsyndromal symptomatic depression: a new mood disorder? J Clin Psychiatry 1994;55(April suppl):18–28.
2.
Schneider G, Kruse A, Nehen HG, Senf W, Heuft G: The prevalence and differential diagnosis of subclinical depressive syndromes in inpatients 60 years and older. Psychother Psychosom 2000;69:251–260.
3.
Pincus HA, Davis WW, McQueen LE: ‘Subthreshold’ mental disorders: a review and synthesis of studies on minor depression and other ‘brand names’. Br J Psychiatry 1999;174:288–296.
4.
Rapaport MH, Judd LL: Minor depressive disorder and subsyndromal depressive symptoms: functional impairment and response to treatment. J Affect Disord 1998;48:227–232.
5.
Hermens MLM, van Hout HPJ, Terluin B, van der Windt DAWM, Beekman ATF, van Dyck R, de Haan M: The prognosis of minor depression in the general population: a systematic review. Gen Hosp Psychiatry 2004;26:453–462.
6.
Backenstrass M, Frank A, Joest K, Hingman S, Mundt C, Kronmuller KT: A comparative study of nonspecific depressive symptoms and minor depression regarding functional impairment and associated characteristics in primary care. Comp Psychiatry 2006;47:35–41.
7.
Chopra MP, Zubritsky C, Knott K, Ten Have T, Hadley T, Coyne JC, Oslin DW: Importance of subsyndromal symptoms of depression in elderly patients. Am J Geriatr Psychiatry 2005;13:597–606.
8.
Gonzalez-Tejera G, Canino G, Ramirez R, Chavez L, Shrout P, Bird H, Bravo M, Martinez-Taboas A, Ribera J, Bauermeister J: Examining minor and major depression in adolescents. J Child Psychol Psychiatry 2005;46:888–899.
9.
Lyness JM, Moonseong H, Datto CJ, Ten Have TR, Katz IR, Drayer R, Reynolds CF, Alexopoulos GS, Bruce ML: Outcomes of minor and subsyndromal depression among elderly patients in primary care settings. Ann Intern Med 2006;144:496–504.
10.
Kessler RC, Zhao S, Blazer DG, Swartz M: Prevalence, correlates, and course of minor depression and major depression in the National Comorbidity Survey. J Affect Disord 1997;45:19–30.
11.
Ackermann RT, Williams JW: Rational treatment choices for non-major depressions in primary care: an evidence-based review. J Gen Intern Med 2002;17:293–301.
12.
Goldney RD, Fisher LJ, Dal Grande E, Taylor AW: Subsyndromal depression: prevalence, use of health services and quality of life in an Australian population. Soc Psychiatry Psychiatr Epidemiol 2004;39:293–298.
13.
Rapaport MH, Judd LL, Schettler PJ, Yonders KA, Thase ME, Kupfer DJ, Frank E, Plewes JM, Tollefson GD, Rush AJ: A descriptive analysis of minor depression. Am J Psychiatry 2002;159:637–643.
14.
Wagner HR, Burns BJ, Broadhead WE, Yarnall KSH, Sigmon A, Gaynes BN: Minor depression in family practice: functional morbidity, co-morbidity, service utilization and outcomes. Psychol Med 2000;30:1377–1390.
15.
Beekman ATF, Deeg DJH, Braam AW, Smit JH, van Tilburg W: Consequences of major and minor depression in later life: a study of disability, well-being and service utilization. Psychol Med 1997;27:1397–1409.
16.
Xavier FMF, Ferraza MPT, Argimon I, Trentini CM, Poyares D, Bertollucci PH, Bisol LW, Moriguchi EH: The DSM-IV ‘minor depression’ disorder in the oldest-old: prevalence rate, sleep patterns, memory function, and quality of life in elderly people of Italian descent in Southern Brazil. Int J Geriatr Psychiatry 2002;17:107–116.
17.
Cuijpers P, de Graaf R, van Dorsselaer S: Minor depression: risk profiles, functional disability, health care use and risk of developing major depression. J Affect Disord 2004;79:71–79.
18.
Ten Have M, de Graaf R, Vollebergh W, et al: What depressive symptoms are associated with the use of care services? Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). J Affect Disord 2004;80:239–248.
19.
Fergusson DM, Horwood LJ, Ridder EM, et al: Beautrais: subthreshold depression in adolescence and mental health outcomes in adulthood. Arch Gen Psychiatry 2005;62:66–72.
20.
Fogel J, Eaton WW, Ford DE: Minor depression as a predictor of the first onset of major depressive disorder over a 15-year follow-up. Acta Psychiatr Scand 2006;113:36–43.
21.
Koenig HG, Vandermeer J, Chambers A, Burr-Crutchfield L, Johnson JL: Comparison of major and minor depression in older medical inpatients with chronic heart and pulmonary disease. Psychosomatics 2006;47:296–303.
22.
McCusker J, Cole M, Dufouil C, Dendukuri N, Latimer E, Windholz S, Elie M: The prevalence and correlates of major and minor depression in older medical inpatients. J Am Geriatr Soc 2005;53:1344–1353.
23.
Allen BP, Agha Z, Duthie EH, Layde PM: Minor depression and rehabilitation outcome for older adults in subacute care. J Behav Health Serv Res 2004;31:189–198.
24.
Rieckmann N, Burg MM, Gerin W, Chaplin WF, Clemow L, Davidson KW: Depression vulnerabilities in patients with different levels of depressive symptoms after acute coronary syndromes. Psychother Psychosom 2006;75:353–361.
25.
Rafanelli C, Roncuzzi R, Finos L, Tossani E, Tomba E, Mangelli L, Urbinati S, Pinelli G, Fava GA: Psychological assessment in cardiac rehabilitation. Psychother Psychosom 2003;72:343–349.
26.
Rafanelli C, Roncuzzi R, Milaneschi Y, Tomba E, Colistro MC, Pancaldi LG, Di Pasquale G: Stressful life events, depression and demoralization as risk factors for acute coronary heart disease. Psychother Psychosom 2005;74:179–184.
27.
Gabryelewicz T, Styczynska M, Pfeffer A, Wasiak B, Barczak A, Luczywek E, Androsiuk W, Barcikowska M: Prevalence of major and minor depression in elderly persons with mild cognitive impairment – MADRS factor analysis. Int J Geriatr Psychiatry 2004;19:1168–1172.
28.
Starkstein SE, Jorge R, Mizrahi R, Robinson RG: The construct of minor and major depression in Alzheimer’s disease. Am J Psychiatry 2005;162:2086–2093.
29.
Elderkin-Thompson V, Mintz J, Haroon E, Lavretsky H, Kumar A: Executive dysfunction and memory in older patients with major and minor depression. Arch Clin Neuropsychol 2006;21:669–676.
30.
Costa A, Peppe A, Carlesimo GA, Pasqualetti P, Caltagirone C: Major and minor depression in Parkinson’s disease: a neuropsychological investigation. Eur J Neurology 2006;13:972–980.
31.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4 (DSM-IV). Washington, American Psychiatric Association Press, Inc, 1994.
32.
First MB, Spitzer RL, Gibbon M, Williams JBW: Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV). Washington, American Psychiatric Press, Inc, 1996.
33.
Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;12:56–62.
34.
Ware JE, Snow KK, Kosinski M, Gandek B: SF-36 Health Survey: Manual and Interpretation Guide. Boston, New England Medical Center, Health Institute, 1993.
35.
Judd LL, Rapaport MH, Yonders KA, Rush AJ, Frank E, Thase ME, Kupfer DJ, Plewes JM, Schettler PJ, Tollefson GD: Randomized placebo-controlled trial of fluoxetine for acute treatment of minor depressive disorder. Am J Psychiatry 2004;161:1864–1871.
36.
Rush AJ, Gullion CM, Basco MR, Jarrett RB, Trivedi MH: The Inventory of Depressive Symptomatology (IDS): psychometric properties. Psychol Med 1996;26:477–486.
37.
Rush AJ, Carmody TJ, Reimitz PE: The Inventory of Depressive Symptomatology (IDS): clinician (IDS-C) and self-report (IDS-SR) ratings of depressive symptoms. Int J Methods Psychiatr Res 2000;9:45–59.
38.
Trivedi MH, Rush AJ, Ibrahim HM, Carmody TJ, Biggs MM, Suppes T, Crismon ML, Shores-Wilson K, Toprac MG, Dennehy EB, Witte B, Kashner TM: The Inventory of Depressive Symptomatology, Clinician Rating (IDS-C) and Self-Report (IDS-SR), and the Quick Inventory of Depressive Symptomatology, Clinician Rating (QIDS-C) and Self-Report (QIDS-SR) in public sector patients with mood disorders: a psychometric evaluation. Psychol Med 2004;34:73–82.
39.
Guy W: ECDEU Assessment Manuel for Psychopharmacology, Revised. Washington, US Government Printing Office, 1976.
40.
Sherbourne CD, Wells KB, Hays RD, Rogers W, Burnam MA, Judd LL: Subthreshold depression and depressive disorder: clinical characteristics of general medical and mental health specialty outpatients. Am J Psychiatry 1994;151:1777–1784.
41.
Kroenke K: Minor depression: midway between major depression and euthymia. Ann Intern Med 2006;144:528–530.
42.
De Figueiredo JM: Demoralization and psychotherapy: a tribute to Jerome D. Frank, MD, PhD (1909–2005). Psychother Psychosom 2007;76:129–133.
43.
Maj M: Are we able to differentiate between true mental disorders and homeostatic reactions to adverse life events? Psychother Psychosom 2007;76:257–259.
44.
Fava GA, Tomba E, Grandi S: The road to recovery from depression – don’t drive today with yesterday’s map. Psychother Psychosom 2007;76:260–265.
45.
Maddux RE, Rapaport MH: Psychopharmacology and psychotherapy of subsyndromal depressions; in Alpert JE, Fava M (eds): Handbook of Chronic Depression. New York, Dekker, 2004, pp 183–206.
46.
Maina G, Forner F, Bogetto F: Randomized controlled trial comparing brief dynamic and supportive therapy with waiting list condition in minor depressive disorders. Psychother Psychosom 2005;74:43–50.
47.
Judd LL, Akiskal HS, Maser JD, Zeller PJ, Endicott J, Coryell W, Paulus MP, Kunovac JL, Leon AC, Mueller TI, Rice JA, Keller MB: A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders. Arch Gen Psychiatry 1998;55:694–700.
© 2008 S. Karger AG, Basel
2008
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.