Cited by 1,043Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Research TopicsTreatment of Major Depression

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Depression is not a consistent syndrome: An investigation of unique symptom patterns in the STAR*D study

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Fried, Eiko I., Nesse, Randolph M.·2015·Journal of Affective Disorders

DOI 10.1016/j.jad.2014.10.010PMC PMC4397113

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Abstract

Background The DSM-5 encompasses a wide range of symptoms for Major Depressive Disorder (MDD). Symptoms are commonly added up to sum-scores, and thresholds differentiate between healthy and depressed individuals. The underlying assumption is that all patients diagnosed with MDD have a similar condition, and that sum-scores accurately reflect the severity of this condition. To test this assumption, we examined the number of DSM-5 depression symptom patterns in the "Sequenced Treatment Alternatives to Relieve Depression" (STAR*D) study.Methods We investigated the number of unique symptom profiles reported by 3703 depressed outpatients at the beginning of the first treatment stage of STAR*D.Results Overall, we identified 1030 unique symptom profiles. Of these profiles, 864 profiles (83.9%) were endorsed by five or fewer subjects, and 501 profiles (48.6%) were endorsed by only one individual. The most common symptom profile exhibited a frequency of only 1.8%. Controlling for overall depression severity did not reduce the amount of observed heterogeneity.Limitations Symptoms were dichotomized to construct symptom profiles. Many subjects enrolled in STAR*D reported medical conditions for which prescribed medications may have affected symptom presentation.Conclusions The substantial symptom variation among individuals who all qualify for one diagnosis calls into question the status of MDD as a specific consistent syndrome and offers a potential explanation for the difficulty in documenting treatment efficacy. We suggest that the analysis of individual symptoms, their patterns, and their causal associations will provide insights that could not be discovered in studies relying on only sum-scores.

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Authors: Fried, E. I., & Nesse, R. M.
Affiliations: KU Leuven (BE)
Arizona State University (US)
Corresponding author: Fried, Eiko I.
ORCID: Fried, Eiko I.
Nesse, Randolph M.
Venue: Journal of Affective Disorders
Publisher: Elsevier BV
Published: 2015-02
Volume: 172
Pages: 96-102
ISSN: 0165-0327 (ISSN-L)
DOI: 10.1016/j.jad.2014.10.010
PMC: PMC4397113
OpenAlex: W2164104699
Cited by: 1,043
References: 79
Citations by year: 2026: 146 · 2025: 138 · 2024: 130 · 2023: 124 · 2022: 95 · 2021: 109 · 2020: 104 · 2019: 74 · 2018: 34 · 2017: 33 · 2016: 34 · 2015: 20
FWCI: 40.35
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Affective Disorders (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (n01mh90003-26-0-0)
National Institute of Mental Health (N01 MH090003)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
Keywords: major depressive disorder, symptom heterogeneity, depression severity, outpatients
MeSH terms: Adult, Depression, Depressive Disorder, Major, Major Depressive Disorder, Female, Humans, Male, Middle Aged, Outpatients, Severity of Illness Index, Treatment Outcome, Diagnostic and Statistical Manual of Mental Disorders

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Depression is not a consistent syndrome: An investigation of unique symptom patterns in the STAR*D study

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