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October
1, 2004
UCSD-Led, Multi-Center Study Indicates Minor
Depression Is Effectively Treated With Medication
By Sue Pondrom
Minor depression,
an underdiagnosed and undertreated subset of major depressive
disorder that affects upwards of 15 million Americans*,
can be effectively treated with a drug called a selective serotonin
reuptake inhibitor (SSRI), according to a multi-center study
led by the University of California, San Diego (UCSD) School
of Medicine and published in the October 2004 issue of the American
Journal of Psychiatry.
“This is especially
important since patients with minor depression are not only
at risk for significant psychosocial impairment, but for major
depressive episodes that can be even more debilitating,”
said the study’s lead author, Lewis L. Judd, M.D., professor
of psychiatry and chair of the UCSD Department of Psychiatry
He added that unclear
categories of illness and diagnosis in the past have led psychiatrists
to generally consider minor depression to be a negligible condition
that didn’t require any treatment. While some mental health
professionals have considered minor depression to be a non-specific
variation of normal mood, more recent studies have identified
it as a clinically significant medical condition.**
Now, urging that minor
depression can and should be treated, Judd said the new study
of 162 patients with minor depressive disorder showed that patients
given the SSRI fluoxetine (brand name Prozac) over a 12-week
period showed significantly greater improvement in mood and
psychosocial function as compared to depressed patients receiving
a placebo. Several standard psychiatric tests were used to compare
the results.***
The National Institute
of Mental Health (NIMH) notes that minor depression is a common
disorder that can impair a person’s functioning and quality
of life, and serve as a serious risk factor for major depression.
The difference between major and minor depression is the number
of symptoms. Major depressive disorder includes the primary
criteria of sadness plus at least five symptoms (such as insomnia,
weight loss or gain, low energy, difficulty concentrating, reduction
in sexual drive, suicidal ideas and/or behavior, psychomotor
slowing, restlessness or irritability, inertia to initiate activity,
and persistent physical symptoms, such as headache or digestive
disorders, that don’t respond to treatment); minor depression
includes the same primary sadness plus one or two additional
symptoms.
Judd, a former director
of the NIMH and a national expert on depression, said “minor
depression is the same as or a less severe variant of major
depressive disorder. Significantly, it doesn’t reach the
threshold of a major depression. In previous studies, we’ve
seen that depressive symptoms wax and wane over an individual’s
lifetime, with most depressed patients usually suffering from
minor depression more of the time than major depression.”
Because it impairs
individuals, Judd and the other leaders of the study recommend
treatment for minor depression, especially before it balloons
into a major episode. His co-leaders and co-authors of the study
were A. John Rush, M.D., University of Texas Southwestern Medical
Center, Dallas; and David J. Kupfer, M.D., University of Pittsburgh.
The UCSD study coordinator
and co-author of the paper was Mark H. Rapaport, M.D., then
a member of the UCSD Department of Psychiatry and currently
chair of the Department of Psychiatry at Cedars-Sinai Medical
Center, Los Angeles, California. Rapaport noted that the study
“is one of the first and largest studies to evaluate the
efficacy of an SSRI in the treatment of a well characterized
cohort of subjects with minor depression. It has shown us that
treating less than major depression with an SSRI does work.”
Additional authors
of the study were Kimberly A. Yonkers, M.D., Yale University
School of Medicine; Ellen Frank, Ph.D. and Michael E. Thase,
M.D., University of Pittsburgh; John M. Plewes, M.D., Pamela
J. Schettler, Ph.D., and Gary Tollefson, M.D., Ph.D., Eli Lilly
& Co.
The study was funded
by an unrestricted investigator-initiated contract from Eli
Lilly & Co. and by grants from the NIMH and the Roher Fund
of the University of California, San Diego.
# #
#
* Source
= National Institute of Mental Health (NIMH)
The NIMH definition of depression: A depressive disorder is
an illness that involves the body, mood, and thoughts. It affects
the way a person eats and sleeps, the way one feels about oneself,
and the way one thinks about things. A depressive disorder is
not the same as a passing blue mood. It is not a sign of personal
weakness or a condition that can be willed or wished away. People
with a depressive illness cannot merely "pull themselves
together" and get better. Without treatment, symptoms can
last for weeks, months, or years. Appropriate treatment, however,
can help most people who suffer from depression.
**
American Journal of Psychiatry 2002, 159:637-643.
***
Inventory of Depressive Symptomatology, Hamilton Depression
Rating Scale, Beck Depression Inventory, the Clinical Global
Impression severity scale, and the Global Assessment of Functioning
Scale.
To interview
Dr. Judd, contact: Sue Pondrom
(619) 543-6163
To interview
Dr. Rapaport, contact: Kelli
Hanley Cedars-Sinai Medical Center
(310) 423-3674
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