Korean Journal of Biological Psychiatry (생물정신의학)

The Korean Society of Biological Psychiatry (대한생물정신의학회)
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Subsyndromal Depression

아증후군적 우울증

  • Park, Joon-Hyuk (Department of Psychiatry, Jeju National University Hospital, School of Medicine, Jeju National University) ;
  • Kim, Ki-Woong (Department of Psychiatry, Seoul National University Bundang Hospital, College of Medicine, Seoul National University)
  • 박준혁 (제주대학교 의학전문대학원 제주대학교병원 정신건강의학교실) ;
  • 김기웅 (서울대학교 의과대학 분당서울대학교병원 정신건강의학교실)
  • Received : 2011.09.16
  • Accepted : 2011.11.03
  • Published : 2011.11.30
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Abstract

Subsyndromal depression (SSD) is found to be more prevalent than major depressive disorder (MDD) and minor depressive disorder (MnDD). SSD is also associated with adverse clinical outcomes, increased risk of suicide, increased social dysfunction and disability, increased risk for future mood disorders, and increased uses of medical and mental health services. DSM-IV diagnostic criteria are not suitable for capturing SSD. Although there is no agreement on gold standard to define SSD so far, three definitions of SSD are available. First, SSD is defined as having two or more current depressive symptoms without core depressive symptoms (depressive mood or loss of interest) and with time threshold (most of the day and nearly every day over at least two weeks). Second, SSD is defined as having two or more current depressive symptoms with core depressive symptoms and without time threshold. Third, SSD is defined by using cutoff points of depression rating scales. SSD may represent a prodromal, residual, or interepisode symptomatic state in the course of MDD and MnDD. More than a half of SSD patients became any type of depressive disorders (SSD, MnDD and MDD) at 1 year. SSD may represent a discrete category of its own, without prior or consequent episodes of MDD. Considering clinical significance of SSD such as its high prevalence, significant psychosocial impairment and chronicity and serious outcomes, researchers and clinicians should be more vigilant in capturing and caring for patients with SSD.

Keywords

References

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th ed. Washington DC: American Psychiatric Association;2000.
  2. Henderson AS, Jorm AF, MacKinnon A, Christensen H, Scott LR, Korten AE, et al. The prevalence of depressive disorders and the distribution of depressive symptoms in later life: a survey using Draft ICD-10 and DSM-III-R. Psychol Med 1993;23:719-729. https://doi.org/10.1017/S0033291700025496
  3. Lebowitz BD, Pearson JL, Schneider LS, Reynolds CF 3rd, Alexopoulos GS, Bruce ML, et al. Diagnosis and treatment of depression in late life. Consensus statement update. JAMA 1997;278:1186-1190. https://doi.org/10.1001/jama.1997.03550140078045
  4. Hybels CF, Blazer DG, Pieper CF. Toward a threshold for subthreshold depression: an analysis of correlates of depression by severity of symptoms using data from an elderly community sample. Gerontologist 2001;41:357-365. https://doi.org/10.1093/geront/41.3.357
  5. Broadhead WE, Blazer DG, George LK, Tse CK. Depression, disability days, and days lost from work in a prospective epidemiologic survey. JAMA 1990;264:2524-2528. https://doi.org/10.1001/jama.1990.03450190056028
  6. Wagner HR, Burns BJ, Broadhead WE, Yarnall KS, Sigmon A, Gaynes BN. Minor depression in family practice: functional morbidity, co-morbidity, service utilization and outcomes. Psychol Med 2000; 30:1377-1390. https://doi.org/10.1017/S0033291799002998
  7. Judd LL. Pleomorphic expressions of unipolar depressive disease: summary of the 1996 CINP President's Workshop. J Affect Disord 1997;45:109-116. https://doi.org/10.1016/S0165-0327(97)00064-5
  8. Judd LL, Rapaport MH, Paulus MP, Brown JL. Subsyndromal symptomatic depression: a new mood disorder? J Clin Psychiatry 1994; 55 Suppl:18-28.
  9. Flint AJ. The complexity and challenge of non-major depression in late life. Am J Geriatr Psychiatry 2002;10:229-232.
  10. Geiselmann B, Bauer M. Subthreshold depression in the elderly: qualitative or quantitative distinction? Compr Psychiatry 2000;41: 32-38. https://doi.org/10.1016/S0010-440X(00)80006-1
  11. Chopra MP, Zubritsky C, Knott K, Have TT, Hadley T, Coyne JC, et al. Importance of subsyndromal symptoms of depression in elderly patients. Am J Geriatr Psychiatry 2005;13:597-606.
  12. Lyness JM, Kim J, Tang W, Tu X, Conwell Y, King DA, et al. The clinical significance of subsyndromal depression in older primary care patients. Am J Geriatr Psychiatry 2007;15:214-223. https://doi.org/10.1097/01.JGP.0000235763.50230.83
  13. 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.
  14. Lavretsky H, Kumar A. Clinically significant non-major depression: old concepts, new insights. Am J Geriatr Psychiatry 2002;10: 239-255.
  15. Judd LL, Akiskal HS, Maser JD, Zeller PJ, Endicott J, Coryell W, et al. Major depressive disorder: a prospective study of residual subthreshold depressive symptoms as predictor of rapid relapse. J Affect Disord 1998;50:97-108. https://doi.org/10.1016/S0165-0327(98)00138-4
  16. Judd LL, Akiskal HS, Maser JD, Zeller PJ, Endicott J, Coryell W, et al. A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders. Arch Gen Psychiatry 1998;55:694-700. https://doi.org/10.1001/archpsyc.55.8.694
  17. 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. https://doi.org/10.1007/s00127-004-0745-5
  18. McAvay GJ, Bruce ML, Raue PJ, Brown EL. Depression in elderly homecare patients: patient versus informant reports. Psychol Med 2004;34:1507-1517. https://doi.org/10.1017/S0033291704002582
  19. Lyness JM, Heo M, Datto CJ, Ten Have TR, Katz IR, Drayer R, et al. Outcomes of minor and subsyndromal depression among elderly patients in primary care settings. Ann Intern Med 2006;144:496- 504. https://doi.org/10.7326/0003-4819-144-7-200604040-00008
  20. Bruce ML, Ten Have TR, Reynolds CF 3rd, Katz II, Schulberg HC, Mulsant BH, et al. Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial. JAMA 2004;291:1081-1091. https://doi.org/10.1001/jama.291.9.1081
  21. Lyness JM, King DA, Cox C, Yoediono Z, Caine ED. The importance of subsyndromal depression in older primary care patients: prevalence and associated functional disability. J Am Geriatr Soc 1999;47:647-652.
  22. da Silva Lima AF, Fleck M, Pechansky F, de Boni R, Sukop P. Psychometric properties of the World Health Organization quality of life instrument (WHOQoL-BREF) in alcoholic males: a pilot study. Qual Life Res 2005;14:473-478. https://doi.org/10.1007/s11136-004-5327-1
  23. Lyness JM, Caine ED, King DA, Cox C, Yoediono Z. Psychiatric disorders in older primary care patients. J Gen Intern Med 1999;14: 249-254. https://doi.org/10.1046/j.1525-1497.1999.00326.x
  24. Williams JB. A structured interview guide for the Hamilton Depression Rating Scale. Arch Gen Psychiatry 1988;45:742-747. https://doi.org/10.1001/archpsyc.1988.01800320058007
  25. Chang SM, Hahm BJ, Lee JY, Shin MS, Jeon HJ, Hong JP, et al. Cross-national difference in the prevalence of depression caused by the diagnostic threshold. J Affect Disord 2008;106:159-167. https://doi.org/10.1016/j.jad.2007.07.023
  26. Noh S, Speechley M, Kaspar V, Wu Z. Depression in Korean immigrants in Canada. I. Method of the study and prevalence of depression. J Nerv Ment Dis 1992;180:573-577. https://doi.org/10.1097/00005053-199209000-00005
  27. Judd LL, Akiskal HS, Paulus MP. The role and clinical significance of subsyndromal depressive symptoms (SSD) in unipolar major depressive disorder. J Affect Disord 1997;45:5-17; discussion 17-8. https://doi.org/10.1016/S0165-0327(97)00055-4
  28. Blazer D, Williams CD. Epidemiology of dysphoria and depression in an elderly population. Am J Psychiatry 1980;137:439-444.
  29. Ernst C, Angst J. Depression in old age. Is there a real decrease in prevalence? A review. Eur Arch Psychiatry Clin Neurosci 1995;245: 272-287. https://doi.org/10.1007/BF02191869
  30. Mulsant BH, Ganguli M. Epidemiology and diagnosis of depression in late life. J Clin Psychiatry 1999;60 Suppl 20:9-15.
  31. Lavretsky H, Kumar A. Practical geriatrics: clinically significant nonmajor geriatric depression. Psychiatr Serv 2003;54:297-299. https://doi.org/10.1176/appi.ps.54.3.297
  32. Tannock C, Katona C. Minor depression in the aged. Concepts, prevalence and optimal management. Drugs Aging 1995;6:278-292. https://doi.org/10.2165/00002512-199506040-00003
  33. Akiskal HS, Judd LL, Gillin JC, Lemmi H. Subthreshold depressions: clinical and polysomnographic validation of dysthymic, residual and masked forms. J Affect Disord 1997;45:53-63. https://doi.org/10.1016/S0165-0327(97)00059-1
  34. Angst J. Recurrent brief depression. A new concept of depression. Pharmacopsychiatry 1990;23:63-66. https://doi.org/10.1055/s-2007-1014484
  35. Horwath E, Johnson J, Klerman GL, Weissman MM. Depressive symptoms as relative and attributable risk factors for first-onset major depression. Arch Gen Psychiatry 1992;49:817-823. https://doi.org/10.1001/archpsyc.1992.01820100061011
  36. Maier W, Gansicke M, Weiffenbach O. The relationship between major and subthreshold variants of unipolar depression. J Affect Disord 1997;45:41-51. https://doi.org/10.1016/S0165-0327(97)00058-X
  37. Lyness JM, Chapman BP, McGriff J, Drayer R, Duberstein PR. Oneyear outcomes of minor and subsyndromal depression in older primary care patients. Int Psychogeriatr 2009;21:60-68. https://doi.org/10.1017/S1041610208007746
  38. Johnson J, Weissman MM, Klerman GL. Service utilization and social morbidity associated with depressive symptoms in the community. JAMA 1992;267:1478-1483. https://doi.org/10.1001/jama.1992.03480110054033
  39. Grabovich A, Lu N, Tang W, Tu X, Lyness JM. Outcomes of subsyndromal depression in older primary care patients. Am J Geriatr Psychiatry 2010;18:227-235. https://doi.org/10.1097/JGP.0b013e3181cb87d6
  40. Pinquart M, Duberstein PR, Lyness JM. Treatments for later-life depressive conditions: a meta-analytic comparison of pharmacotherapy and psychotherapy. Am J Psychiatry 2006;163:1493-1501. https://doi.org/10.1176/appi.ajp.163.9.1493
  41. Oxman TE, Sengupta A. Treatment of minor depression. Am J Geriatr Psychiatry 2002;10:256-264.
  42. Lyness JM. Treatment of depressive conditions in later life: real-world light for dark (or dim) tunnels. JAMA 2004;291:1626-1628. https://doi.org/10.1001/jama.291.13.1626
  43. Miranda J, Munoz R. Intervention for minor depression in primary care patients. Psychosom Med 1994;56:136-141.
  44. Fava GA, Rafanelli C, Grandi S, Conti S, Belluardo P. Prevention of recurrent depression with cognitive behavioral therapy: preliminary findings. Arch Gen Psychiatry 1998;55:816-820. https://doi.org/10.1001/archpsyc.55.9.816
  45. Barkham M, Shapiro DA, Hardy GE, Rees A. Psychotherapy in two-plus-one sessions: outcomes of a randomized controlled trial of cognitive-behavioral and psychodynamic-interpersonal therapy for subsyndromal depression. J Consult Clin Psychol 1999;67:201- 211.
  46. Klerman GL, Weissmann MM. Interpersonal psychotherapy (IPT) and drugs in the treatment of depression. Pharmacopsychiatry 1987; 20:3-7. https://doi.org/10.1055/s-2007-1017067
  47. Rapaport MH, Judd LL. Minor depressive disorder and subsyndromal depressive symptoms: functional impairment and response to treatment. J Affect Disord 1998;48:227-232. https://doi.org/10.1016/S0165-0327(97)00196-1
  48. Tadic A, Helmreich I, Mergl R, Hautzinger M, Kohnen R, Henkel V, et al. Early improvement is a predictor of treatment outcome in patients with mild major, minor or subsyndromal depression. J Affect Disord 2010;120:86-93. https://doi.org/10.1016/j.jad.2009.04.014
  49. Kendler KS, Gardner CO Jr. Boundaries of major depression: an evaluation of DSM-IV criteria. Am J Psychiatry 1998;155:172-177.
  50. Judd LL, Paulus MP, Zeller P. The role of residual subthreshold depressive symptoms in early episode relapse in unipolar major depressive disorder. Arch Gen Psychiatry 1999;56:764-765.