Minor depressive disorder is both common and associated with significant psychosocial impairment. This study examined antidepressant treatment efficacy in a large group of patients with minor depressive disorder.
One hundred sixty-two patients with minor depressive disorder were randomly assigned to receive fluoxetine or placebo in a 12-week, double-blind study; 73% (59 of 81) of the patients in each treatment group completed the study. Patients were evaluated weekly with standard depression rating instruments and measures of psychosocial impairment. Hypotheses were tested by last-observation-carried-forward analysis of variance (ANOVA) and confirmed by mixed (random-effects) regression analysis.
At baseline, minor depressive disorder patients were mildly to moderately depressed, with a corresponding degree of functional impairment. Over 12 weeks of treatment, both ANOVA and mixed regression showed fluoxetine to be superior to placebo as indicated by significantly greater improvement of fluoxetine-treated patients in scores on the 30-item clinician-rated Inventory of Depressive Symptomatology, the 17-item and 21-item Hamilton Depression Rating Scale, the Beck Depression Inventory, and the Clinical Global Impression severity scale. Improvement in Global Assessment of Functioning Scale score was significantly greater for the fluoxetine group in mixed regression analysis only. Patients in both treatment groups reported a similar number and severity of adverse events during the 12-week treatment period.
Clinicians frequently encounter minor depressive disorder either as a prodromal or residual phase of illness in major depressive disorder or as de novo minor depressive disorder episodes. Fluoxetine is significantly superior to placebo in reducing minor depressive disorder symptoms within a 12-week period. Improvement in psychosocial function with fluoxetine may take longer than 12 weeks.
"e symptoms in affected individuals ( Judd , 2012 ) . Given the importance of detecting the earliest manifestations of psychiatric disorders ( Insel , 2009 ) , characterization of early prognostic risk factors such as SD for incident major depression and related disorders may help identify individuals who may benefit from preventive interventions ( Judd et al . 2004 ; Cuijpers et al . 2007 ; Rosenberg et al . 2010 ) ."
[Show abstract][Hide abstract] ABSTRACT: Background:
Subsyndromal depression (SD) may increase risk for incident major depressive and other disorders, as well as suicidality. However, little is known about the prevalence, course, and correlates of SD in the US general adult population. Method Structured diagnostic interviews were conducted to assess DSM-IV Axis I and II disorders in a nationally representative sample of 34 653 US adults who were interviewed at two time-points 3 years apart.
A total of 11.6% of US adults met study criteria for lifetime SD at Wave 1. The majority (9.3%) had <5 total symptoms required for a diagnosis of major depression; the remainder (2.3%) reported ⩾5 symptoms required for a diagnosis of major depression, but denied clinically significant distress or functional impairment. SD at Wave 1 was associated with increased likelihood of developing incident major depression [odds ratios (ORs) 1.72-2.05], as well as dysthymia, social phobia, and generalized anxiety disorder (GAD) at Wave 2 (ORs 1.41-2.92). Among respondents with SD at Wave 1, Cluster A and B personality disorders, and worse mental health status were associated with increased likelihood of developing incident major depression at Wave 2.
SD is prevalent in the US population, and associated with elevated rates of Axis I and II psychopathology, increased psychosocial disability, and risk for incident major depression, dysthymia, social phobia, and GAD. These results underscore the importance of a dimensional conceptualization of depressive symptoms, as SD may serve as an early prognostic indicator of incident major depression and related disorders, and could help identify individuals who may benefit from preventive interventions.
Psychological Medicine 10/2012; 43(7):1-14. DOI:10.1017/S0033291712002309 · 5.94 Impact Factor
"Despite the high prevalence and associated functional impairment, there is limited evidence that antidepressants are of clinically significant benefit to persons with minor depression (Goldberg, Privett, Ustun, Simon, & Linden, 1998; Guy, Ban, & Schaffer, 1983; Linden et al., 1999; Paykel, Freeling, & Hollyman, 1988) (but see (Judd et al., 2004). Similarly, for people with minor depression, there is limited evidence for the effectiveness of manual driven, structured psychotherapies such as cognitive-behavioral therapy (CBT) (Cuijpers, van Straten, & Warmerdam, 2007; Oxman & Sengupta, 2002) or the most widely used psychosocial treatment in primary care, nonspecific " counseling " (Orleans, George, Houpt, & Brodie, 1985; Robinson et al., 1995; Spitzer et al., 1995). "
[Show abstract][Hide abstract] ABSTRACT: Research was undertaken to compare problem-solving treatment for primary care (PST-PC) with usual care for minor depression and to examine whether treatment effectiveness was moderated by coping style. PST-PC is a 6-session, manual-based, psychosocial skills intervention. A randomized controlled trial was conducted in 2 academic, primary care clinics. Those subjects who were eligible were randomized (N = 151), and 107 subjects completed treatment (57 PST-PC, 50 usual care) and a 35-week follow-up. Analysis with linear mixed modeling revealed significant effects of treatment and coping, such that those in PST-PC improved at a faster rate and those initially high in avoidant coping were significantly more likely to have sustained benefit from PST-PC.
Journal of Consulting and Clinical Psychology 01/2009; 76(6):933-43. DOI:10.1037/a0012617 · 4.85 Impact Factor
"Greater duration of depressive episode (over time scales of 1–2 years) is associated with a poorer response to placebo (Stewart, et al., 1989; Khan, et al., 1991; Stewart, et al., 1993), with less effect on response to antidepressants (Khan, et al., 1991; Joyce, et al., 2002; Trivedi, et al., 2006b) suggesting increasing drug-placebo difference with increasing duration. Two studies with lower than expected placebo improvement rates, one in subthreshold depression (24% defined as 'not depressed' on placebo at the end of the study, Judd, et al., 2004) and one in adolescents (35% response rate, March, et al., 2004) required a minimum duration of stable depressed mood prospectively for 4 weeks or retrospectively for 6 weeks, respectively, and found significant advantage for an antidepressant. A naturalistic follow-up study of recurrent major depressive episodes found a high natural recovery rate without taking antidepressants for many patients experiencing a relapse in the first 3 months (Posternak, et al., 2006b). "
[Show abstract][Hide abstract] ABSTRACT: A revision of the 2000 British Association for Psychopharmacology evidence-based guidelines for treating depressive disorders with antidepressants was undertaken to incorporate new evidence and to update the recommendations where appropriate. A consensus meeting involving experts in depressive disorders and their management was held in May 2006. Key areas in treating depression were reviewed, and the strength of evidence and clinical implications were considered. The guidelines were drawn up after extensive feedback from participants and interested parties. A literature review is provided, which identifies the quality of evidence to inform the recommendations, the strength of which are based on the level of evidence. These guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing and management, next-step treatment, relapse prevention, treatment of relapse, and stopping treatment.
Journal of Psychopharmacology 07/2008; 22(4):343-96. DOI:10.1177/0269881107088441 · 3.59 Impact Factor
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