Major Depression, Minor Depression, and Double Depression: Are They Distinct Clinical Entities?

Department of Psychiatry, St. Paul's Hospital, Vancouver, Canada.
American Journal of Medical Genetics (Impact Factor: 3.23). 07/1996; 67(4):347-53. DOI: 10.1002/(SICI)1096-8628(19960726)67:4<347::AID-AJMG6>3.0.CO;2-J
Source: PubMed


The clinical concept of "double depression," i.e., the superimposition of a major depressive disorder in a patient with dysthymic disorder, implies that there are at least some differences between dysthymia, major depression, and double depression. However, the relationship between these two syndromes remains unclear. The present study uses genetic methodology to explore any possible relationship between minor depression, double depression, and major depression. From 1988-1990, all consecutive unrelated inpatients and outpatients (index cases) presenting to a university-based mood disorders service had detailed family histories taken, using modification of the "family history method." Diagnoses for index cases and their first-degree relatives were made according to Research Diagnostic Criteria. For all index cases with a diagnosis of minor or intermittent depression, and minor/intermittent depression plus either single or recurrent depression ("double depression"), morbidity risks for mood disorders were calculated for first-degree relatives (parents, siblings, and children) using the maximum likelihood approach. Results showed no significant differences in morbidity risk calculations to first-degree relatives of index cases with minor/intermittent depression, major depression, or double depression. The data from this genetic perspective suggest that single depression, recurrent depression, minor depression, and double depression are indistinguishable.

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    • ".8% had minor depression, and 2% had major depression; minor depression was associated with a significantly greater decline in functional status and performance, as well as with increased risk of death in men; major depression increased risk of functional decline and death in men and women Penninx et al., (1998) 71 Epidemiologic follow-up of community samples (the established populations for epidemiologic studies of elderly subjects) 4,825 persons age 71 years and older followed up at 3 and 6 years Chronic depression (CES-D) based on cut-off criteria When present for at least 6 years, depression was associated with a generally increased risk of cancer, after controlling for age, sex, race, disability, hospital admissions, alcohol intake, and smoking Neuroimaging Kumar et al., (1998) 102 Cross-sectional, quantitative MRI study; whole-brain volumes and normalized measures of prefrontal and temporal volumes 18 subjects with minor depression, 35 patients with late-onset major depression, and 30 normalcontrol subjects Major and minor depression Normalized prefrontal lobe volumes show a significant linear trend with severity of depression, with volumes decreasing with depression severity Genetics Anderson et al., (1996) 121 Family study of subaffective, character spectrum, and primary dysthymia 97 early-onset dysthymic outpatients received diagnostic interview and family history interviews Dysthymia, subaffective disorder Subaffective depression subjects had higher rates of major depression, depressive symptoms, and depressive personality features, as well as higher rate of alcoholism in families Remick et al., (1996) 91 Family study Examined first-degree relatives of probands with depressive-spectrum diagnosis Probands with minor depression, major depression, dysthymia, and " double " depression When morbidity risks were calculated using the maximum-likelihood approach for the first-degree relatives, results showed no significant differences in morbidity risk to firstdegree relatives "
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    ABSTRACT: Clinically significant non-major depression has been underinvestigated despite its high prevalence and public health impact. Although there is an increasing recognition of the importance of non-major forms of depression, their nosological boundaries and neurobiological mechanisms remain largely unknown. The authors discuss the literature pertaining to the current concepts, phenomenology, neurobiology, and treatment approaches to geriatric non-major clinically significant depression. They examine the similarities and differences between various subtypes of depressive disorders and compare non-major, clinically significant depression in elderly patients with non-geriatric adult populations. They draw conclusions from the published literature and propose clinical criteria for the diagnosis of clinically significant non-major depression in elderly persons.
    Full-text · Article · May 2002 · American Journal of Geriatric Psychiatry
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    ABSTRACT: The purpose of our study was to examine the neuroanatomical correlates of late-onset minor and major depression and to compare them with similar measures obtained from nondepressed controls. Our study groups were comprised of 18 patients with late-onset minor depression, 35 patients diagnosed with late-onset major depression, and 30 nondepressed controls. All subjects were scanned by using a 1. 5-tesla MRI scanner. Absolute whole brain volume and normalized measures of prefrontal and temporal lobe volumes were obtained and used for comparison among groups. Our findings indicate that patients with minor depression present with specific neuroanatomical abnormalities that are comparable with the major depression group but significantly different from the controls. Normalized prefrontal lobe volumes show a significant linear trend with severity of depression, with volumes decreasing with illness severity. Whole brain volumes did not differ significantly among groups. These findings have broad implications for the biology of late-life depression and suggest that there may be common neurobiological substrates that underlie all clinically significant forms of late-onset mood disturbances.
    Preview · Article · Jul 1998 · Proceedings of the National Academy of Sciences
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    ABSTRACT: Dysthymia is a chronic disease with a high psychosocial burden. Age of onset frequently is in young adulthood. It is clinically characterized by very mild but continuous chronic depressive symptoms. The quality of symptoms seems to be similar to episodic depressive disorders, but the severity criteria for major depression are not fulfilled. After more than 2 years of dysthymia a depressive episode may occur (double depression). Neurobiological and genetic findings indicate a relation of dysthymia to affective disorders. Antidepressants are proven to be effective without a difference between various types of drugs. Psychotherapy is also proven to be effective (e.g. behaviour therapy) and should be prescribed in combination or alone, if a patient refused to take drugs. Because of the preferable side-effect profile of newer antidepressant compounds, they should be prescribed as first choice. A prophylactic treatment for 2 years is recommended. The dose of antidepressants should be in the therapeutic range for treatment of major depression.
    No preview · Article · Feb 1999 · Wiener Medizinische Wochenschrift
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