This leads to roughly 1,000 unique combinations of symptoms that all qualify for a diagnosis of MDD, some of which do not share a single symptom. Moreover, three symptoms – sleep problems, weight/appetite problems, and psychomotor problems – encompass opposite features (insomnia vs. Of note, all symptoms except the first contain sub-symptoms (e.g., diminished interest or pleasure). To qualify for the diagnosis, an individual must exhibit five or more symptoms, one of which must be either depressed mood or anhedonia. recurrent thoughts of death or recurrent suicidal ideation. diminished ability to think or concentrate, or indecisiveness and 9. feelings of worthlessness or inappropriate guilt 8. increase or decrease in either weight or appetite 4. markedly diminished interest or pleasure 3. In the DSM-5, MDD is characterized by nine symptoms: 1.
This review shows that this common practice discards much critical information about individual symptoms whose analysis can provide important insights. This practice of constructing sum-scores and collapsing individuals with different symptoms into one undifferentiated category is based on the assumption that depression is a single condition, and that all symptoms are interchangeable and equally good indicators. The severity of MDD is routinely estimated by adding up severity scores for many disparate symptoms to create a sum-score, and threshold values for these sum-scores are commonly used to classify individuals as depressed or not depressed.
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About 60% of individuals meeting criteria for MDD, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), report severe or very severe impairment of functioning that highly compromises the capacity for self-care and independent living. It is the leading cause of disability worldwide, and one of the top three causes of disease burden worldwide. Major depressive disorder (MDD) is one of the most common psychiatric disorders, with an estimated lifetime prevalence rate in the USA of 16.2%. It may be politically important to utter such simplifications to doctors in general medical settings, but it is a convenient fiction.” “ At present major depression has become a monolith, with the assumption that the diagnosis can be made merely on the number of depressive symptoms present. We offer specific suggestions with practical implications for future research. The analysis of individual symptoms and their causal associations offers a way forward. We suggest that the pervasive use of sum-scores to estimate depression severity has obfuscated crucial insights and contributed to the lack of progress in key research areas such as identifying biomarkers and more efficacious antidepressants.
Furthermore, specific life events predict increases in particular depression symptoms, and there is evidence for direct causal links among symptoms. Here, we review a host of studies documenting that specific depressive symptoms like sad mood, insomnia, concentration problems, and suicidal ideation are distinct phenomena that differ from each other in important dimensions such as underlying biology, impact on impairment, and risk factors. This method – and research results based on it – are valid if depression is a single condition, and all symptoms are equally good severity indicators. Most measures of depression severity are based on the number of reported symptoms, and threshold scores are often used to classify individuals as healthy or depressed.
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