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Cited by 775Treatment of Major DepressionMental Health Research TopicsBipolar Disorder and Treatment

A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders

Judd, Lewis L., Akiskal, Hagop S., Maser, Jack D., Zeller, Pamela J., Endicott, Jean, Coryell, William, Paulus, Martin P., Kunovac, Jelena L. +4 more·1998·Archives of General Psychiatry
DOI 10.1001/archpsyc.55.8.694
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Abstract

BACKGROUND: Investigations of unipolar major depressive disorder (MDD) have focused primarily on major depressive episode remission/recovery and relapse/recurrence. This is the first prospective, naturalistic, long-term study of the weekly symptomatic course of MDD. METHODS: The weekly depressive symptoms of 431 patients with MDD seeking treatment at 5 academic centers were divided into 4 levels of severity: (1) depressive symptoms at the threshold for MDD; (2) depressive symptoms at the threshold for minor depressive or dysthymic disorder (MinD); (3) subsyndromal or subthreshold depressive symptoms (SSDs), below the thresholds for MinD and MDD; and (4) no depressive symptoms. The percentage of weeks at each level, number of changes in symptom level, and medication status were analyzed overall and for 3 subgroups defined by mood disorder history. RESULTS: Patients were symptomatically ill in 59% of weeks. Symptom levels changed frequently (1.8/y), and 9 of 10 patients spent weeks at 3 or 4 different levels during follow-up. The MinD (27%) and SSD (17%) symptom levels were more common than the MDD (15%) symptom level. Patients with double depression and recurrent depression had more chronic symptoms than patients with their first lifetime major depressive episode (72% and 65%, respectively, vs 46% of follow-up weeks). CONCLUSION: The long-term weekly course of unipolar MDD is dominated by prolonged symptomatic chronicity. Combined MinD and SSD level symptoms were about 3 times more common (43%) than MDD level symptoms (15%). The symptomatic course is dynamic and changeable, and MDD, MinD, and SSD symptom levels commonly alternate over time in the same patients as a symptomatic continuum of illness activity of a single clinical disease.

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Crossref · 10.1001/archpsyc.55.8.694

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  • Some investigators have argued and provided evidence that minor and major depression fall along a continuum of a single clinical disorder.

    “Some investigators have argued and provided evidence for the contention that minor and major depression fall along a continuum of a single clinical disorder.37”

    From Subthreshold Symptoms of Depression in Preadolescent Girls Are Stable and Predictive of Depressive Disorders (2008) · cites this paper as [37]

  • The idiom 'thinking too much' denotes a broader mental health syndrome, with manifestations such as sadness, lack of motivation, poor concentration, sleep difficulties and irritability, perhaps similar to the construct of 'common mental disorders'.

    “The idiom 'thinking too much' denotes a broader mental health syndrome, with manifestations such as sadness, lack of motivation, poor concentration, sleep difficulties and irritability, perhaps similar to the construct of 'common mental disorders'. 112-117”

    From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [116]

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Authors
Judd, L. L., Akiskal, H. S., Maser, J. D., Zeller, P. J., Endicott, J., Coryell, W., Paulus, M. P., Kunovac, J. L., Leon, A. C., Mueller, T. I., Rice, J. A., & Keller, M. B.
Affiliations
University of California San Diego (US)
ORCID
Venue
Archives of General Psychiatry
Publisher
American Medical Association (AMA)
Published
1998-08-01
Volume
55
Issue
8
Pages
694
ISSN
0003-990X (ISSN-L)
DOI
10.1001/archpsyc.55.8.694
OpenAlex
W2135297770
Cited by
775
References
29
Citations by year
2026: 8 · 2025: 6 · 2024: 9 · 2023: 13 · 2022: 17 · 2021: 19 · 2020: 13 · 2019: 17 · 2018: 22 · 2017: 21 · 2016: 22 · 2015: 23 · 2014: 38 · 2013: 24 · 2012: 36
FWCI
16.83
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health
  • Centers for Disease Control and Prevention (PHSMH49671, PHSMH30914)
  • National Institute of Mental Health (R01MH025478)
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords
unipolar major depression, subsyndromal depressive symptoms, subthreshold depression, minor depressive disorder, dysthymia, chronicity of depression, double depression, recurrent depression, first-episode depression
MeSH terms
Adult, Antidepressive Agents, Chronic Disease, Depressive Disorder, Female, Follow-Up Studies, Humans, Male, Prospective Studies, Recurrence, Severity of Illness Index, Dysthymic Disorder

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