Consider a fictional patient, Marta. Marta’s life hasn’t been going well for the past month. She has been feeling quite sad, crying at the slightest provocation. She is suffering from insomnia and is very fatigued. She constantly compares her failures to others’ successes, which makes her feel worthless. Her boss is annoyed that she has called in sick from work the past 3 days, but she just could not handle the stress of her work environment.
Her appetite is normal, however. She is not suicidal, in fact she still finds enjoyment in all of her hobbies and interests. She is neither distracted nor forgetful, but her thinking is as clear as it ever has been.
Is Marta depressed?
The DSM-IV defines two depressive disorders, Major Depressive Disorder and dysthymia. In order to have MDD, a patient must have at least 5 of the following 9 symptoms, and one of these must be one of the first two. In addition, the symptoms must have occurred for at least two weeks.
- Depressed mood most of the day, nearly everyday.
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
- Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in amonth), or decrease or increase in appetite nearly every day.
- Insomnia or hypersomnia nearly every day
- Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
- Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
Dysthymia is milder, but typically more chronic than MDD. It is diagnosed when a patient has 2-4 depressive symptoms for at least 2 years.
Marta has only 4 symptoms-depressed mood, sleep disorder, fatigue, and feelings of worthlessness. She is off the list for MDD. She doesn’t qualify for dysthymia either, since she has only been sick for a month. Under the current system, she would be given a diagnosis of Depressive Disorder Not Otherwise Specified, meaning that her depression defies categorization.
Despite being undefined by the DSM-IV, Marta’s condition is neither uncommon nor unrecognized. Mental health professionals and researchers call it “Minor Depressive Disorder” (MinD). Patients with MinD have 2-4 of the DSM depressive symptoms, and these mood problems persist for at least two weeks.
Though the condition is mild relative to major depression, which can be disabling, the term “minor” depression is deceiving. Some patients, like Marta, find that it interferes with their work attendance and performance. Others experience problems with relationships, as depressive feelings often cause patients to isolate themselves. Long-lasting minor depression can be fatal, as even mild depressive symptoms have been associated with a significant increase in an individual's lifetime suicide risk. Also, minor depression appears to be more of a long-term illness than a transient frame of mind, with many patients experiencing mood symptoms for months. Minor depression significantly increases a sufferers risk of developing major depression, as well. A history of childhood emotional abandonment increases this risk.
Since minor depression causes life difficulties and increases the risk of further mental health problems, it warrants treatment. Little is known on how to treat minor depression, however, as most depression research has focused on the most severe forms of depression. Of the few studies that have been done, most have found that antidepressant medications are no more effective than a placebo in mild to moderate depression. Patients are often encouraged to try herbal remedies, such as St.John's wart, but some research has found that these treatments also are less than efficacious. Many patients with MinD try to work out their problems in therapy.
Minor depression is a long-term condition that prevents people from reaching their full potential in work and social situations, increases their risk for major depressive disorder, and generally causes them to feel miserable. Worse yet, few effective treatments are known. For someone like Marta, suffocating in the haze of minor depression, these are all serious concerns.
Sources:
- Cuijpers, P & Graaf, R. (April 2004) Minor Depression: Risk Profiles, Functional Disablility, Health Care Use, and Risk of Developing Major Depression. Journal of Affective Disorders, 79. Retrieved from Risk, Disability, and Health Care Use in Minor Depression
- Major Depressive Episode. Retrieved from Depressive Episode Criteria
- Rapaport, M.H, Judd, L.L, Schettler, P.J, Yonkers, K.A, Thase, M.E, Kupfer, D.J, Frank, E, Plewes, J.M, Tollefson, G.D, & Rush, A.J. (April 2002) A Descriptive Analysis of Minor Depression. The American Journal of Psychiatry, 159. Retrieved from A Descriptive Analysis of Minor Depression
- Rapaport, M.H, Nierenberg, A.A, Howland, R, Dording, C, Schettler, P. J, & Mischoulon, D (July 2011) The Treatment of Minor Depression with St. John's Wart or Citalopram: Failure to Show Benefit Over Placebo. Journal of Psychiatric Research, 45. Retrieved from St. John's Wart and Medication No Better than Placebo for Minor Depression
Sara Stewart - Sara Stewart is a pre-med, pre-psychiatry student studying neurobiology at a university in the United States.
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