Subsyndromal symptomatic depression: A new concept

Although DSM-IV acknowledged the clinical significance of some subthreshold forms Of unipolar depression, such as minor depression (MinD) and recurren t brief depression (RBD), clinicians continued to struggled with the concep t of "sub-threshold" depression. A substantial number of patients continued to present with depressive symptoms that still did nor satisfy any DSM-IV diagnosis. Generally, these patients failed to complain of anhedonia and de pressed mood a cu criterion that DSM-IV mandates for any diagnosis of depre ssion. Therefore, researchers reexamined the question of whether this duste r of depressive symptoms, in the absence of anhedonia and depressed mood wa s clinically significant. Some researchers labeled this cluster of symptoms , "subsyndromal symptomatic depression" (SSD). Specifically, SSD is defined ns a depressive state having two or more symptoms of depression of the sam e quality ns in major depression (MD), excluding depressed mood and anhedon ia. The symptoms must be present for move than 2 weeks and be associated wi th social dysfunction. Using Medline Search, the authors reviewed the liter ature on the epidemiology, demographics, clinical characteristics, and psyc hosocial impairment of SSD. SSD is found to be comparable in demographics a nd clinical characteristics to MD, MinD, and dysthymia. SSD is also associa ted with significant psychosocial dysfunction ns compared with healthy subj ects. Further; it has significant risk for suicide and future MB. Few studi es have been conducted on the treatment of SSD. The high prevalence of SSD, the significant psychosocial impairment associated with it, and the chroni city of its course make subsyndromal symptomatic depression a matter for se rious consideration by clinicans and researchers. (C) 2000 Wiley-Liss, Inc.