PLEOMORPHIC EXPRESSIONS OF UNIPOLAR DEPRESSIVE DISEASE - SUMMARY OF THE 1996 CINP PRESIDENTS WORKSHOP

Data presented during the 1996 CINP President's Workshop supported the conclusion that unipolar major depressive disorder (MDD) is a pleomor phic mood disorder consisting of a cluster of depressive subtypes exis ting in a relatively homogeneous symptomatic clinical continuum, exten ding from subsyndromal depressive symptomatology (SSD) through minor d epressive episode, dysthymic disorder, major depressive episode and do uble depression. This indicates that common unipolar depressive subtyp es can be conceptualized as alternate forms or different symptomatic p hases of the same parent illness. Although there appears to be great o verlap across time in the symptomatological expressions of these clini cal depressive subtypes, they may be derived from different etiologica l and genetic factors. The one exception may be major depressive episo de with psychotic features, which exists on a severity continuum with other subtypes of unipolar MDD, but does not appear to be on a symptom atic continuum with dysthymic, subsyndromal or minor depressions. By c ontrast, SSD and minor depressive disorder represent clinically signif icant depressive subtypes, which are commonly observed during the cour se of illness of patients with unipolar major depressive illness. Comp ared to no depressive symptoms, SSD is associated with harmful dysfunc tion, as evidenced by significant increases in psychosocial impairment , signifying that SSD is an active, inter-episode disease state of uni polar major depressive disorder. Finally, SSD, possibly jointly with s ubthreshold anxiety symptoms, may also represent potent risk factors f or rapid depressive episode relapse. In the aggregate, these findings and conclusions have broad and important implications for diagnostic a nd treatment strategies of unipolar MDD. (C) 1997 Elsevier Science B.V .