An Overview of Subsyndromal Symptomatic Depression

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Subsyndromal symptomatic depression (SSD) is a term that indicates that a person's depression symptoms don't quite meet the criteria for a diagnosis of a major depressive episode.

By definition, subsyndromal means that people experience clusters of depressive symptoms but do not meet the DSM-5 diagnostic criteria for a depressive disorder. This can include those with brief, recurring episodes of depressive as well as minor symptoms. 

Subsyndromal symptomatic depression was first identified and labeled in 1994 by researchers who defined it as two or more symptoms consistent with depression. Like depression, the symptoms must have been present for two weeks or more and have caused social dysfunction, such as isolation, withdrawal, or behavior changes.

It's thought that subsyndromal symptomatic depression symptoms may be a risk factor for developing clinically significant major depressive disorder in the future.

Symptoms

Symptoms that develop on a daily or almost daily basis and that may occur in both SSD and major depression are:

  • Feeling sad or depressed
  • A significant change in appetite and/or weight
  • Needing too much or not getting enough sleep
  • Either being noticeably restless or being run down
  • Not enjoying the activities you once did
  • Feeling wiped out or fatigued
  • Feeling hopeless, worthless, and/or guilty
  • Having trouble concentrating or making decisions
  • Having thoughts of death or suicide or suicidal behavior

The difference in these symptoms is that with depression, you must have at least five of the symptoms to be diagnosed. With SSD, you only experience two to four of these symptoms.

Mild Symptoms Should Be Noted

We all know early intervention is the key to successful treatment, so if mental health professionals note even mild depressive symptoms, treatment may very well be indicated so that symptoms do not become worse. With studies showing that even mild symptoms are fairly disabling, it's important to help people with subsyndromal symptomatic depression and other depressive subthreshold disorders function at their best.

Causes

Depression is a complex condition and a range of factors can contribute to its onset. Some risk factors that increase the likelihood that a person will experience symptoms of depression include genetics, family history, abuse, trauma, some medications, major life changes, stress, illness, and substance use. 

In cases where a person is experiencing subsyndromal symptomatic depression, it means that they have many of the signs of depression, but not enough for a clinical diagnosis. There are a number of reasons why a person might not meet the diagnostic criteria for depression. This might be because they have good coping skills or a strong social support system that makes it so that their symptoms do not impair functioning in different life areas. 

However, having even mild symptoms of depression might also be a contributing cause to later clinical depression.

Diagnosis

Many people have depressive symptoms that don't quite meet the criteria for being diagnosed with major depression.

Studies suggest that subsyndromal symptomatic depression has just as much of an impact on function and has the same risk factors as major depression. Subsyndromal depression also has the same negative effects on overall health as major depression does.

Some researchers believe that there is a spectrum of depression, from fewer symptoms to symptoms that don't last long to severe symptoms, and that all depressive episodes, despite their severity, have similar adverse effects on individuals.

One study that used a broad sampling of people from a variety of countries across the globe showed that subsyndromal depression seems to be quite a significant problem worldwide.

Because of its detrimental effects, more research needs to be done on subtypes of depressive disorder. Researchers suggest that mental health professionals should take note of even minimal depressive symptoms since they are harmful to a person's overall health.

Potential Challenges in Diagnosing Depression

The same study notes that clinicians are very good at ruling out depression, but not nearly as successful at diagnosing it. This could be due to the thresholds that are set in the Diagnostic and Statistical Manual (DSM) and the difficulties in assessing the significance of depressive symptoms. There is a challenge in identifying people who are close to the threshold of depression set out in the DSM. The researchers of this study came to the conclusion that further research is needed and that SSD should be classified on its own and potentially treated similarly to major depression.

Treatment

Because subsyndromal symptomatic depression often goes without being diagnosed, it is thought to be undertreated. The available research suggests that psychotherapy and antidepressants may both be effective at reducing depressive symptoms.

Medications

One study found that treatment with SSRI antidepressants led to the improvement in symptoms and functioning, suggesting that low doses of SSRIs may be useful in alleviating SSD symptoms.

Psychotherapy

Studies have also shown that interpersonal therapy and cognitive-behavior therapy can also lead to improvements in functioning and decreases in depressive symptoms.

Lifestyle Changes

Self-care and lifestyle changes can also help people find relief. Some things that may help include getting regular exercise, eating a healthy diet, getting adequate sleep, and having a strong social support system. Depression can often cause people to become more isolated, so reaching out to trusted friends and loved ones can be beneficial.

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