An Overview of Subsyndromal Symptomatic Depression

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By definition, subsyndromal describes a person is exhibiting symptoms that are similar to but not severe enough for diagnosis as a clinically recognized syndrome. When applied to depression, subsyndromal symptomatic depression (SSD) indicates that a person's depression symptoms don't quite meet the criteria for a diagnosis of a major depressive episode. SSD can include people who experience brief, recurring episodes of depressive symptoms. 

Subsyndromal symptomatic depression has been labeled somewhat differently by different researchers. One definition is two or more symptoms consistent with depression.

The current diagnostic and statistic manual of mental disorders (DSM-5) would classify subsyndromal depression in the category of "other specified depressive disorder," likely as a "depressive episode with insufficient symptoms."

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 include:

  • 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 major depression, you must have at least five of the symptoms to be diagnosed. With SSD, you will experience less of these symptoms.

Mild Symptoms Should Be Noted

Early intervention is the key to successful treatment, so if mental health professionals note even mild depressive symptoms, treatment may very well be indicated to ensure that symptoms don't become worse. With studies showing that even mild symptoms can be 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 formal diagnosis. There are a number of reasons why a person might not meet the diagnostic criteria for depression.

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 can have just as much of an impact on function and has the same risk factors as major depression. And subsyndromal depression may also have the same negative effects on overall health as major depression does.

Some researchers believe that there is a spectrum or continuum of depressive symptoms.

One 2013 study that used a broad sampling of people from a variety of countries across the globe showed that subsyndromal depression seems to be 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 2013 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 as seen in people with major depressive disorder (MDD).

Medications

One study found that treatment with selective serotonin reuptake inhibitors (SSRIs) antidepressants led to the improvement in symptoms and functioning.

Psychotherapy

Studies have also shown that various types of psychotherapy such as interpersonal therapy and cognitive behavior therapy (CBT) 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.

If you or a loved one are struggling with depression, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

A Word From Verywell

While subsyndromal symptomatic depression does not meet the diagnostic criteria for a major depressive episode, it can still have a significant impact on a person's life and functioning. Effective treatments including medications and psychotherapy can help people who are experiencing symptoms. Talk to your doctor if you are experiencing feelings of depression, even if these symptoms are mild or if you only have a few of them. Help is available and your doctor can recommend treatments that will help you feel better.

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  2. Rapaport MH, Judd LL. Minor depressive disorder and subsyndromal depressive symptoms: functional impairment and response to treatment. J Affect Disord. 1998;48(2-3):227-32. doi:10.1016/s0165-0327(97)00196-1

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