The Clinical Spectrum of So-called “Minor” Depressions

Abstract

Reviewing the recent literature on the overlapping spectrum of neurotic depressive and dysthymic conditions--unofficially referred to as "minor," "atypical" or "characterologic" depressives--the authors conclude that significant symptomatologic admixtures with anxiety disorders do not represent the prototypical features of these disorders as defined in DSM-III-R. It is long-standing anhedonia on an intermittent or chronic basis which appears to characterize the trait illness of dysthymia. The emerging data on dysthymia suggest that it begins early in life, is often complicated by major depressions, and pursues a chronic--often pernicious--course. The development of hypomanic switches during the prospective course of some of these patients further suggests some kinship to bipolar disorder. Although traditionally conceived as being largely "psychogenic," familial data and selected biologic indices--especially in the area of sleep--and thymoleptic responsiveness impart some credibility to the role of biologic factors in the origin of these disorders. Given the high prevalence of dysthymic conditions in clinical practice, new research strategies on their causes are needed as a precondition for more rational treatment approaches.

Dysthymia: a review of pharmacological and behavioral factors

“…18 Because dysthymia was initially thought to be more of a characterological disturbance than a biologically-based illness, and because of the oft-noted superiority of pharmacotherapy in major depression relative to that observed in dysthymia, 17 the illness was typically treated using different forms of psychotherapy. [19][20][21] As such, the lack of controlled studies comparing the relative efficacy of psychotherapy and pharmacotherapy (either alone or in combination) is surprising. It was recently reported, however, that in the short-run, pharmacotherapy (using a selective serotonin reuptake inhibitor) was more efficacious than group cognitive behavior therapy (CBT) in alleviating symptoms of dysthymia, 22 although CBT attenuated several functional aspects of the illness.…”

Endocrine and cytokine correlates of major depression and dysthymia with typical or atypical features

“…It has been proposed that two subtypes of dysthymia exist, one of which may have a biological basis (subaffective) and the other being characterological in nature. 31,32 The former is associated with early age-of-onset, and is amenable to pharmacotherapy. 33,34 Unlike major depression, [34][35][36] dysthymia is not accompanied by elevations of plasma adrenocorticotrophic hormone (ACTH) and cortisol, nonsuppression of cortisol release following dexamethasone challenge, nor a blunted ACTH response to CRH challenge.…”

Late-onset minor and major depression: early evidence for common neuroanatomical substrates detected by using MRI

“…In addition, minor depression is a well recognized risk factor for MDD in adult and geriatric populations (15,16). Additionally, family studies indicate that there may be a genetic predisposition to both major and minor forms of depression (17)(18)(19)(20). Despite these observations, there is little understanding about the neurobiological substrates of minor depression, especially in the elderly (21).…”

“…In addition, the role of common neuroanatomical substrates to late-onset mood disorders in general remains unknown. Published reports on the genetic, pharmacologic, and other clinical aspects of minor depression focus largely on younger, adult populations (14,(16)(17)(18)(19). We are not aware of other published data on the neurobiological correlates of minor depression occurring for the first time in late-life-lateonset minor depression (21).…”